The epidemiology of sudden cardiac deaths (SCDs) was turned on its head Thursday, with research showing that in reality, ischemic cardiac disease is not the leading driver of SCDs, as previously thought. [MEDPAGE TODAY]

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From a prospective autopsy study of unselected deaths in San Francisco County, California, it was evident that out of 943 presumed SCDs, 62% were autopsy-confirmed, and only 41% of those were due to myocardial infarction (MI) upon comprehensive postmortem and histologic evaluation -- "one-half the long-accepted 80% prevalence among SCDs," according to Zian Tseng, MD, MAS, of University of California San Francisco, and colleagues of the POST SCD study.

For the remaining 59% of autopsy-confirmed SCDs not traced to an MI, they can be explained by a range of causes including hypertensive heart disease, dilated cardiomyopathy, substance-related cardiomyopathy, and normal heart primary electrical disease. When an MI was involved, nine in ten cases were attributed to acute or healed MI with obstructive coronary artery disease, and one in ten related to acute MI with nonobstructive coronary arteries (MINOCA).

The study was presented at the annual meeting of the Heart Rhythm Society (HRS), held in Chicago this year. A full manuscript was published in the Journal of the American College of Cardiology.

Importantly, the countywide study did not rely on coronary angiographic data obtained from patients who survived the initial resuscitation, a source of potential selection bias in prior studies.

"For decades, MI was considered the leading cause of SCD," according to an accompanying editorial by Florence Dumas, MD, PhD, and Alain Cariou, MD, PhD, both of Paris Cité University, Inserm. "Consequently, most research and management efforts have been focused on MI as a cause of SCD."

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Illinois has more severe racial and ethnic health disparities compared to other states in the Great Lakes region, according to a report released Wednesday by The Commonwealth Fund.  [Health News Illinois]

Black people experienced the lowest health system performance in Illinois, scoring in the 33rd percentile nationally. Illinois ranked 24th out of 39 states for the population.

Meanwhile, Illinois ranked 13th out of 46 states and the District of Columbia for health system performance for Hispanic people, with the state scoring in the 45th percentile. 

It ranked 4th out of 31 states on health system performance for Asian American, Native Hawaiian and Pacific Islander populations, scoring in the 96th percentile.

Illinois ranked 22nd out of 50 states and the District of Columbia for health system performance for white people, scoring in the 81st percentile.

The report did not rank Illinois for its American Indian and Alaska Native population due to insufficient state data.

The report said that racial and ethnic health disparities exist in every state — and warns that recent federal policy changes are expected to deepen them.

“These changes include Medicaid funding cuts and tightened eligibility, restrictions barring most legal immigrants and asylees from marketplace and Medicaid coverage, and the expiration of enhanced premium tax credits in the marketplaces,” it said. “It is highly likely they have already worsened existing disparities and are on track to widen them further.”

It suggests that policymakers look at investing in social services, strengthening primary care, lowering administrative burdens and ensuring affordable health insurance coverage.

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Key Points

Question  What is the impact of delaying vaccination against hepatitis B virus (HBV) among US infants? [JAMA - Pediatrics]

Authors: Eric W. Hall, PhD, MPH¹; Prabhu Gounder, MD, MPH²; Heather Bradley, PhD³ 

Findings  In this economic evaluation including 3.6 million infants, delaying administration of the first hepatitis B vaccine dose from birth to age 2 months for a single annual US birth cohort among infants whose birthing parents test negative for HBV could result in additional preventable HBV infections among children by age 18 years, including hepatocellular carcinoma cases, HBV-related deaths, and millions of dollars in excess lifetime health care costs.  

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Meaning  Study results quantify the importance of administering the first hepatitis B vaccine dose at birth for preventing childhood HBV transmission.

Importance  Universal administration of hepatitis B (HepB) vaccine at birth is a cornerstone for hepatitis B virus (HBV) elimination efforts in the US. In 2025, the Advisory Committee on Immunization Practices (ACIP) recommended delaying HepB vaccine initiation among infants born to birth parents who tested negative for hepatitis B surface antigen (HBsAg).

Objective  To evaluate the health and economic impact of delaying HepB vaccination among US infants.

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Advocates for the LGBTQ+ community claimed a win this week after the Trump administration pledged to reinstate the 988 Suicide and Crisis Lifeline specialized support program tailored to their needs. [MEDPAGE TODAY]

During a Senate hearing earlier this week, HHS Secretary Robert F. Kennedy Jr. was asked whether he would commit to restoring the tailored line for LGBTQ+ callers to 988, as required by law, after the Trump administration removed it last summer.

"We are working on getting it up now," Kennedy said.

While most 988 calls are routed to the nearest call center, callers who press 3 or text PRIDE were once connected to a centralized network of trained crisis counselors who have shared lived experiences or are trained to provide services to LGBTQ+ youth.

Linking callers to local resources is usually best, since support outside of a phone call might be needed. However, for those in states where attacks on LGBTQ+ individuals are widespread, local resources may not be preferred, Hannah Wesolowski, chief advocacy officer for the National Alliance on Mental Illness, told MedPage Today.

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Agency issues priority vouchers, clears new clinical research, and advances guidance to support treatments for depression, PTSD, and substance use disorders

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President Trump on April 18 issued an Executive Order directing the U.S. Department of Health and Human Services to accelerate access to treatments for patients with serious mental illness, including devastating, complex, and treatment-resistant conditions.

Building on this directive, the U.S. Food and Drug Administration today announced a series of regulatory actions to support the development of serotonin-2A agonists and related products, a class of perception-altering psychedelic medications.

“Under President Trump’s leadership, we are accelerating the research, approval, and responsible access to promising mental health treatments—including psychedelic therapies like ibogaine—to confront our nation’s mental health crisis head-on, especially for our veterans,” said Health and Human Services Secretary Robert F. Kennedy, Jr. “The FDA will prioritize therapies with Breakthrough Therapy designation, where early evidence shows meaningful improvement over existing options for serious mental illness.”

“These medications have the potential to address the nation’s mental health crisis, including conditions like treatment-resistant depression, alcoholism and other serious mental health and substance abuse conditions,” said FDA Commissioner Marty Makary, M.D., M.P.H. “As this field moves forward, it is critical that their development is grounded in sound science and rigorous clinical evidence. We owe it to our nation’s veterans and all Americans who are suffering from these conditions to evaluate these potential therapies with urgency.”

The FDA is issuing national priority vouchers to three companies studying:

• Psilocybin for treatment-resistant depression.
• Psilocybin for major depressive disorder.
• Methylone for post-traumatic stress disorder (PTSD).

In addition, the agency is allowing an early phase clinical study of noribogaine hydrochloride to move forward following an Investigational New Drug (IND) submission. The sponsor is investigating noribogaine as a potential treatment for alcohol use disorder, a condition with high relapse rates and limited treatment options. This is the first instance in which the FDA has allowed a clinical study in the U.S. of a derivative of ibogaine, a psychoactive indole alkaloid derived from the African Tabernanthe iboga shrub.  This decision allows the company developing the novel drug, DemeRx NB, to begin a phase I clinical study of the drug in a closely monitored clinical setting in the United States.  

The FDA’s decision allows the study to proceed and does not mean the drug has been approved or found to be safe or effective. The agency will continue to review data as it becomes available and support efforts to develop new treatments for alcohol use disorder and other mental health conditions.

Finally, the FDA intends to release final guidance imminently to provide recommendations to sponsors developing these products. Designing clinical trials to evaluate serotonin-2A agonists and related products presents unique scientific and methodological challenges. The final guidance reflects input from public comments and outlines foundational considerations for sponsors, including recommendations related to study design, data collection and generation, patient monitoring and conducting adequate and well-controlled clinical investigations.

“There is a growing recognition of the potential of psychedelic medications to address multiple different psychiatric conditions that are notoriously difficult to treat,” said Tracy Beth Hoeg, M.D., Ph.D., Acting Director of the FDA’s Center for Drug Evaluation and Research. “At the FDA we are showing our support of investigating the safety and efficacy of this class of drugs through today’s actions.”

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The pathway is designed to reduce the delay between FDA authorization and Medicare coverage for certain Class II and Class III breakthrough medical devices. [MEDTECHDIVE]

The Centers for Medicare and Medicaid Services and the Food and Drug Administration have unveiled a new pathway to speed up Medicare coverage for certain breakthrough medical devices.

The pathway, called the Regulatory Alignment for Predictable and Immediate Device, or RAPID, allows the two health agencies to work together, and with companies, during the device review process to speed up Medicare coverage for certain FDA-designated Class II and Class III breakthrough medical devices.

The approach could enable Medicare national coverage and payment as soon as two months after a device has received market authorization, compared with approximately one year or more under the current system, according to the Thursday announcement.

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The head of the Department of Healthcare and Family Services told lawmakers that early discussions are ongoing on ways stakeholders can address the “increasingly fragile” state of Illinois’ safety net health system.[Health News Illinois] 

HFS Director Elizabeth Whitehorn told the House’s Appropriations-Health and Human Services Committee last week that there are 32 Illinois hospitals that meet safety net designation, which received an estimated $2.9 billion for Medicaid services in the 2024 calendar year.

Along with years of structural budget challenges, Whitehorn said many safety nets are struggling to adjust as healthcare moves more toward outpatient, community-based and home-based care models.

HFS has provided advances as a form of bridge funding to enable hospitals to weather emergency financial situations, but Whitehorn said this has also led to a growing number of facilities either falling behind or failing to pay their taxes, which is a “critical revenue source” for the Medicaid program.

“This situation is not sustainable for the healthcare system or the state budget,” she said.

The agency is in the “earliest stages” of a comprehensive planning effort to bring stakeholders together to discuss sustainable strategies and solutions for safety-net providers.

Once running, Whitehorn said the process will include listening sessions, proposed policy changes and enhanced coordination between HFS and the Department of Public Health. The project will be led by Dan Fulwiler, who was appointed last fall as the state’s hospital strategy lead.

“This work does not contemplate closure of safety net hospitals or providers,” Whitehorn said. “It is focused on how we all can best serve patients and work together to leverage efficiencies that will enable safety-net providers to operate more sustainably over time.”

In other business, Whitehorn said they are still working to prepare Illinois for the various changes to the Medicaid program, which includes work requirements set to go into effect next year.

The department’s new estimates are that between 165,00 and 300,000 Illinoisans will lose Medicaid coverage due to the work requirement set to go into effect next year. The new federal definition of qualified aliens is expected to result in coverage loss for approximately 10,000 individuals who currently receive full benefits.

Illinois is facing a nearly $51 billion reduction in Medicaid expenditures over the next decade.

“Never before has the Medicaid program undergone such significant policy changes, let alone in such a short period of time,” Whitehorn said. “While we are confident in our ability to meet these obligations, it places enormous pressure and stress on our staff, systems and partners to ensure we are successful in satisfying the federal requirements while also providing a seamless experience for our customers.”

Whitehorn said the department has hired 220 employees since June 1 to help with the increased demand to implement the federal requirements.

In other business, she told lawmakers they are requesting a $100 million supplemental appropriation for the current fiscal year for the new rural health care transformation fund, which she said will allow them to draw down the roughly $193.4 million in federal funding that Illinois has been awarded.

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Data interoperability is top of mind for public health leaders as they grapple with tightening budgets, changes in reimbursements rates, evolving policy mandates and persistent workforce shortages, according to a new report. [Route 50 and APHA]

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The drive to improve data services comes as agencies nationwide are increasingly turning to artificial intelligence as a tool in government operations to enhance efficiency and streamline workflows, according to a report released Tuesday by data platform company Snowflake. The findings are based on a survey of 183 health care decision-makers, including public health agency officials. 

Indeed, 85% of respondents said data interoperability was a “higher or much higher priority” to their organization than in previous years, while 57% of respondents identified AI implementation as a reason for that, the report found. 

“Interoperability is not a top industry priority simply because regulators have said it should be,” Shahran Haider, deputy chief data officer of NYC Health and Hospitals, said in the report. “It is the connective tissue that enables AI-driven value across the full spectrum of operational efficiency and clinical improvement opportunities, benefiting not just individual organizations, but our health care system and society as a whole.”

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Since publishing roadmap last April, agency has successfully launched several key initiatives to replace animal testing with better alternatives

The U.S. Food and Drug Administration today announced it achieved its key first-year goals in the implementation of its April 2025 Roadmap to Reducing Animal Testing in Preclinical Safety Studies, marking one year of transformative action to modernize drug development through innovative, human-relevant science. 

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"One year ago, we issued an ambitious roadmap to eliminate unnecessary animal testing and replace  animal testing with more precise ways of predicting drug safety in humans," said FDA Commissioner Marty Makary, M.D., M.P.H. "In addition to ushering in more scientifically accurate way to test drugs before they are used in humans, the agency has made great strides to reduce  research and development costs, which will lower drug prices for everyday Americans" 

From a purely scientific standpoint, animals are not a great model of how well drugs perform in humans. Historically, more than 90 percent of drugs that clear animal studies do not receive FDA approval, often due to safety or efficacy issues identified in human trials. To address this gap, FDA is advancing use of new approach methodologies (NAMs)—including advanced in vitro systems, computational modeling, and human-derived platforms—that better reflect human biology and improve prediction of drug effects. 

Unlike previous guidance to industry, the FDA's 2025 roadmap strategy established specific timeframes for phasing out animal testing where equivalent or better alternatives exist. Today, the agency released a follow-up report summarizing the agency's progress in implementing the roadmap and clarifying its next steps. 

Since issuing the roadmap, the agency has:  

• Released draft guidance on the reduction or elimination of nonhuman primate testing in monoclonal antibody development.  
• Updated guidance to support a transition from horseshoe crab-derived endotoxin testing, which could spare more than one million animals per year.
• Working to reduce or eliminate animal used for FDA approval when drugs have demonstrated safety from their broad use in humans in other countries.
• Released draft guidance expanding the use of weight-of-evidence approaches to support the use of NAMs, enabling drug developers to more readily incorporate in vitro assays, computational toxicology, and other human-relevant models to generate evidence across a wider array of safety endpoints.   
• Qualified the first artificial intelligence-based drug development tool, demonstrating the utility of leveraging cutting edge in silico models to support regulatory decision-making.  
• Launched a searchable database clarifying where alternative methods are acceptable, and established close collaboration with international regulators to align strategies.  

To sustain progress, FDA has deployed key infrastructure, including a permanent pathway for qualifying innovative drug development tools, cross-center scientific reviews, and a formal partnership with the National Institutes of Health. Together, these efforts are advancing a shift toward human-relevant science as the default approach to drug evaluation. 

This transition is expected to improve prediction of drug safety, accelerate development timelines, reduce costs, and expand patient access to innovative therapies, while significantly reducing reliance on animal testing. 

FDA will continue working with partners across government, industry, and academia to expand the use of these approaches and further modernize drug development. 

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Healthcare leaders across the U.S. are raising concerns after federal agencies shared intentions earlier this month to significantly revise the Mental Health Parity and Addiction Equity Act. Industry stakeholders say the decision could weaken enforcement, exacerbate access challenges and widen disparities in behavioral healthcare at a time of rising demand. [Becker's Behavioral Health]

Seven behavioral health executives shared their reaction to a recent policy development related to the Mental Health Parity and Addiction Equity Act.

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Editor’s note: Responses have been lightly edited for clarity and length. 

Sheryl Bates. Director of Mental Health Crisis Access and Utilization Management for Endeavour Health (Evanston, Ill.): The 2024 rule represented the most substantial update to parity regulations in nearly a decade, reinforcing requirements for insurers to evaluate and justify limitations on mental health and substance use disorder services. It emphasized transparency, requiring comparative analyses of nonquantitative treatment limitations.  The administration’s decision not to defend the rule introduces uncertainty and delays stronger enforcement. Oversight and accountability are already difficult and this may weaken it further.

Access to care is already a challenge across the country and decisions like this create further risk of it getting worse.

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