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Recent Press Releases
By analyzing reported physical activity levels over time in more than 11,000 American adults, Johns Hopkins Medicine researchers conclude that increasing physical activity to recommended levels over as few as six years in middle age is associated with a significantly decreased risk of heart failure, a condition that affects an estimated 5 million to 6 million Americans.
Similar to how protein clumps build up in the brain in people with some neurodegenerative diseases such as Alzheimer’s and Parkinson’s diseases, protein clumps appear to accumulate in the diseased hearts of mice and people with heart failure, according to a team led by Johns Hopkins University researchers.
In an analysis of clinical data collected on more than 9,000 people, Johns Hopkins researchers have shown that the number of years spent overweight or obese appear to “add up” to a distinct risk factor that makes those with a longer history of heaviness more likely to test positive for a chemical marker of so-called “silent” heart damage than those with a shorter history
Below are brief summaries of story ideas for February’s Valentine’s Day and American Heart Month
Johns Hopkins researchers report successful use of heart imaging to predict the benefit or futility of catheter ablation, an increasingly popular way to treat atrial fibrillation, a common heart rhythm disorder.
In a direct comparison study, Johns Hopkins researchers have added to evidence that a newer method of calculating so-called “bad cholesterol” levels in the blood is more accurate than the older method in people who did not fast before blood was drawn.
A study of more than 400 adults with prehypertension, or stage 1 high blood pressure, found that combining a low-salt diet with the heart-healthy DASH diet substantially lowers systolic blood pressure — the top number in a blood pressure test — especially in people with higher baseline systolic readings.
Anaheim Convention Center
A new study on two specially bred strains of mice has illuminated how abnormal addition of the chemical phosphate to a specific heart muscle protein may sabotage the way the protein behaves in a cell, and may damage the way the heart pumps blood around the body.
Johns Hopkins researchers report that the level, or “copy number,” of mitochondrial DNA—genetic information stored not in a cell’s nucleus but in the body’s energy-creating mitochondria—is a novel and distinct biomarker that is able to predict the risk of heart attacks and sudden cardiac deaths a decade or more before they happen. In the future, testing blood for this genetic information could not only help physicians more accurately predict a risk for life-threatening cardiac events, but also inform decisions to begin—or avoid—treatment with statins and other drugs.
Using fruit flies, Johns Hopkins researchers have figured out why a particular inherited human heart condition that is almost always due to genetic mutations causes the heart to enlarge, thicken and fail. They found that one such mutation interferes with heart muscle’s ability to relax after contracting, and prevents the heart from fully filling with blood and pumping it out.
In a randomized, double-blind, clinical trial of 212 patients, Johns Hopkins researchers have found that the routine use of fentanyl for sedation and comfort during coronary angiography reduces the effectiveness of the platelet blocking drug ticagrelor, and it doesn’t appear to provide any better pain relief than just local anesthesia.
Researchers at the Johns Hopkins University School of Medicine and the Mayo Clinic have compiled peer-reviewed evidence and crafted a guideline designed to help physicians and medical centers stop the use of a widely ordered blood test that adds no value in evaluating patients with suspected heart attack.
In an analysis of medical records gathered from more than 300 hospitalized patients, a team of researchers reports that routine imaging scans used to help diagnose heart attacks generated “incidental findings” (IFs) in more than half of these patients. The investigators say only about 7 percent of these IFs were medically significant and urged imaging experts and hospitals to explore ways to safely reduce the added costly — and potentially risky — days in the hospital the IFs generate.
Flying a stroke specialist by helicopter to a nearby stroke patient for emergency care is feasible, saves money and, most importantly, gets critical care to patients faster than transporting the patient to a hospital first, according to a single-patient, proof-of-concept study by a Johns Hopkins Medicine research team.
Johns Hopkins researchers report that an analysis of survey responses and health records of more than 10,000 American adults for nearly 20 years suggests a “synergistic” link between exercise and good vitamin D levels in reducing the risk of heart attacks and strokes.
A study that surveyed a national sample of emergency department health care providers and adult patients suggests that patients are substantially more willing to disclose their sexual orientation than health care workers believe.
A new study in mice reveals that eosinophils, a type of disease-fighting white blood cell, appear to be at least partly responsible for the progression of heart muscle inflammation to heart failure in mice.
When it comes to your heart health, it’s never too early or too late to start making meaningful changes to your lifestyle. Not only is it important to eat right and move more, but also to know your risks for certain heart diseases and understand your numbers. From learning the best diets for your heart to smart approaches to exercise, our experts provide guidance on keeping your heart in tip-top shape.
Generating mature and viable heart muscle cells from human or other animal stem cells has proven difficult for biologists. Now, Johns Hopkins researchers report success in creating them in the laboratory by implanting stem cells taken from a healthy adult or one with a type of heart disease into newborn rat hearts.
Using data from a national study, Johns Hopkins researchers determined that using heart CT scans can help personalize treatment in patients whose blood pressure falls in the gray zone of just above normal or mild high blood pressure. Previously, the appropriate blood pressure treatment for these patients used risk calculations and some guesswork, potentially leaving many vulnerable to heart disease or taking drugs they don’t need. Nearly one in three adults in the U.S. has prehypertension, blood pressure higher than normal but not considered high yet.
Experts at Johns Hopkins and New York’s Mount Sinai Health System have published a suggested new plan for a five-stage system of classifying the risk of heart attack in those with heart disease, one they say puts much-needed and long-absent focus on the risks faced by millions of Americans who pass so-called stress tests or have less obvious or earlier-stage danger signs.
Results of a new study led by Johns Hopkins researchers offer new evidence for a strong link between angiotensin receptor autoantibodies and increased risk of frailty. In a report on the work, published online in the journal Circulation on Nov. 30, the team says a large class of common blood pressure drugs that target the angiotensin receptor, called angiotensin receptor blockers (ARBs), may help patients depending on the levels of the autoantibodies.
Using specialized CT scans of a healthy heart and one with heart disease, a team of Johns Hopkins cardiologists and biomedical engineers say they’ve created computer models of the “shape” of blood flow through the heart’s upper left chamber that someday may help predict stroke risk.
After analyzing 10 years of medical tests on more than 2,700 people in a federally funded heart disease study, researchers at Johns Hopkins Medicine and elsewhere conclude that taking calcium in the form of supplements may raise the risk of plaque buildup in arteries and heart damage, although a diet high in calcium-rich foods appears be protective.
Several large international groups of researchers report data that more than doubles the number of sites in the human genome tied to blood pressure regulation. One of the studies, by Johns Hopkins University scientists in collaboration with many other groups, turned up unexpected hints that biochemical signals controlling blood pressure may spring from within cells that line blood vessels themselves.
By analyzing medical records gathered over three decades on more than 11,000 Americans participating in a federally funded study, researchers at Johns Hopkins Medicine say they have more evidence that driving diastolic blood pressure too low is associated with damage to heart tissue.
A study by Johns Hopkins researchers of more than 13,000 people has found that even after accounting for such risk factors as high blood pressure, high cholesterol and diabetes, so-called morbid obesity appears to stand alone as a standout risk for heart failure, but not for other major types of heart disease.
A diet rich in fruits, vegetables, low-fat dairy and reduced in fats and saturated fats (the DASH diet), designed decades ago to reduce high blood pressure, also appears to significantly lower uric acid, the causative agent of gout. Further, the effect was so strong in some participants that it was nearly comparable to that achieved with drugs specifically prescribed to treat gout, a new study led by Johns Hopkins researchers shows.
Eliminating racial disparities in the outcomes of programs to control blood pressure can be accomplished with a few one-on-one coaching sessions delivered by health professionals —but not if the program requires people to get to a clinic, according to results of a new Johns Hopkins Medicine study.
Johns Hopkins Medicine researchers report that rising blood levels of a protein called hematoma derived growth factor (HDGF) are linked to the increasing severity of pulmonary arterial hypertension, a form of damaging high blood pressure in the lungs.
Researchers at Johns Hopkins report that a type of lab-grown human nerve cells can partner with heart muscle cells to stimulate contractions. Because the heart-thumping nerve cells were derived from induced pluripotent stem cells that in turn were made from human skin cells, the researchers believe the cells — known as sympathetic nerve cells — will be an aid in studying disorders that affect the nervous system — that is, scientists will be able to grow nerve cells in the lab that replicate particular patients’ diseases.
A 10-year follow-up study of more than 6,000 people who underwent heart CT scans suggests that a high coronary artery calcium score puts people at greater risk not only for heart and vascular disease but also for cancer, chronic kidney disease and chronic obstructive pulmonary disease (COPD).
A popular smartphone app purported to accurately measure blood pressure simply by placing a cellphone on the chest with a finger over the built-in camera lens misses high blood pressure in eight out of 10 patients, according to research from Johns Hopkins.
Researchers at Johns Hopkins and the Henry Ford Health System report evidence that higher levels of physical fitness may not only reduce risk of heart attacks and death from all causes, but also possibly improve the chances of survival after a first attack.
Johns Hopkins has demonstrated in animals that applying a pacemaker’s mild electrical shocks to push the heart in and out of normal synchronized contraction for part of each day may be an effective way to slow down the progression of heart failure, a disorder that afflicts millions of Americans.”
Academic medical centers that take on community partners to form accountable care organizations face a number of unexpected challenges, says Scott Berkowitz, M.D., M.B.A., medical director of accountable care for the Office of Johns Hopkins Physicians and executive director of the Johns Hopkins Medicine accountable care organization (ACO) known as the Johns Hopkins Medicine Alliance for Patients (JMAP).
A study of general surgery residents at The Johns Hopkins Hospital suggests that in the efforts to prevent dangerous blood clots among hospitalized patients, regular, one-on-one feedback and written report cards work a lot better than the usual group lectures that newly minted surgeons receive as part of their training.
Johns Hopkins researchers report that a new study of mouse cells has revealed reasons why attempts to grow stem cells to maturity in the laboratory often fail, and provided a possible way to overcome such “developmental arrest.”
Results of a head-to-head comparison study led by Johns Hopkins researchers show that noninvasive CT scans of the heart’s vessels are far better at spotting clogged arteries that can trigger a heart attack than the commonly prescribed exercise stress that most patients with chest pain undergo.
A federally funded analysis of MRI scans of the aging hearts of nearly 3,000 adults shows significant differences in the way male and female hearts change over time.
Johns Hopkins Hospital has received the American College of Cardiology’s NCDR ACTION Registry-GWTG Platinum Performance Achievement Award for 2015. Johns Hopkins is one of only 319 hospitals nationwide to receive the honor.
A sticky, protein-rich gel created by Johns Hopkins researchers appears to help stem cells stay on or in rat hearts and restore their metabolism after transplantation, improving cardiac function after simulated heart attacks, according to results of a new study.
Analysis of blood samples from more than 5,000 people suggests that a more sensitive version of a blood test long used to verify heart muscle damage from heart attacks could also identify people on their way to developing hypertension well before the so-called silent killer shows up on a blood pressure machine.
People infected with the hepatitis C virus are at risk for liver damage, but the results of a new Johns Hopkins study now show the infection may also spell heart trouble.
Acknowledging key strengths and “lessons learned,” preventive cardiologists from Johns Hopkins and Mayo Clinic have developed a short list of suggested upgrades to the controversial heart disease prevention guidelines issued jointly in 2013 by the American Heart Association and the American College of Cardiology.
A Johns Hopkins-led study of outcomes among 1,200 people with implanted defibrillators — devices intended to prevent sudden cardiac death from abnormal heart rhythms — shows that within a few years of implantation, one in four experienced improvements in heart function substantial enough to put them over the clinical threshold that qualified them to get a defibrillator in the first place.
Researchers have long had reason to hope that blocking the flow of calcium into the mitochondria of heart and brain cells could be one way to prevent damage caused by heart attacks and strokes. But in a study of mice engineered to lack a key calcium channel in their heart cells, Johns Hopkins scientists appear to have cast a shadow of doubt on that theory. A report on their study is published online this week in Proceedings of the National Academy of Sciences.
Working with heart muscle cells from diabetic rats, scientists at Johns Hopkins have located what they say is the epicenter of mischief wreaked by too much blood sugar and used a sugar-gobbling enzyme to restore normal function in the glucose-damaged cells of animal heart muscles.
In what may be a major leap forward in the quest for new treatments of the most common form of cardiovascular disease, scientists at Johns Hopkins report they have found a way to halt and reverse the progression of atherosclerosis in rodents by loading microscopic nanoparticles with a chemical that restores the animals’ ability to properly handle cholesterol.
Mild elevations in blood pressure considered to be in the upper range of normal during young adulthood can lead to subclinical heart damage by middle age — a condition that sets the stage for full-blown heart failure, according to findings of a federally funded study led by scientists at Johns Hopkins.
Research conducted in fruit flies, rats and monkeys by scientists at Johns Hopkins, UC San Diego, and other institutions reveals that levels of a protein called vinculin increase with age to alter the shape and performance of cardiac muscle cells — a healthy adaptive change that helps sustain heart muscle vitality over many decades.
After reviewing outcomes from thousands of cases, researchers at Johns Hopkins report that patients with blocked neck arteries who undergo carotid stenting to prop open the narrowed blood vessels fare decidedly worse if their surgeons re-inflate a tiny balloon in the vessel after the mesh stent is in place.
Bruce A. Perler, M.D., M.B.A., a Johns Hopkins vascular surgeon; the Julius H. Jacobson II, M.D., Professor of Vascular Surgery; vice chair for clinical operations and financial affairs for the Department of Surgery; and chief emeritus of the Division of Vascular Surgery and Endovascular Therapy, will become president of the Society for Vascular Surgery on June 20.
Heart disease has topped mortality charts as the No. 1 killer of men and women for many decades, but a novel analysis of American literary fiction by two physicians finds the disorder’s presence in great novels has remained relatively modest.
Oxidative stress has been long known to fuel disease, but how exactly it damages various organs has been challenging to sort out. Now scientists from Johns Hopkins say research in mice reveals why oxidation comes to be so corrosive to heart muscle.
‘Motion-Tracking’ MRI Tests Reveal Novel Harbingers of Stroke in People with Common Heart Rhythm ...
Researchers from Johns Hopkins performing sophisticated motion studies of heart MRI scans have found that specific altered function in the left atrium — one of the heart’s four chambers — may signal stroke risk in those with a-fib and, possibly, those without it.
Levi Watkins Jr., a pioneer in both cardiac surgery and civil rights who implanted the first automatic heart defibrillator in a patient and was instrumental in recruiting minority students to the Johns Hopkins University School of Medicine, significantly enhancing the institution’s diversity, died on Saturday, April 11, in The Johns Hopkins Hospital of complications from a stroke. He was 70.
Cholesterol-lowering statins have transformed the treatment of heart disease. But while the decision to use the drugs in patients with a history of heart attacks and strokes is mostly clear-cut, that choice can be a far trickier proposition for the tens of millions of Americans with high cholesterol but no overt disease.
Working with lab animals and human heart cells, scientists from Johns Hopkins and other institutions have identified what they describe as “the long-sought culprit” in the mystery behind a cell-signaling breakdown that triggers heart failure.
A team of scientists led by Johns Hopkins cardiologist and biomedical engineer Hiroshi Ashikaga, M.D., Ph.D., has developed a mathematical model to measure and digitally map the beat-sustaining electrical flow between heart cells.
Analyzing data from 58,000 heart stress tests, Johns Hopkins cardiologists report they have developed a formula that estimates one’s risk of dying over a decade based on a person’s ability to exercise on a treadmill at an increasing speed and incline.
Most “risk calculators” used by clinicians to gauge a patient’s chances of suffering a heart attack and guide treatment decisions appear to significantly overestimate the likelihood of a heart attack, according to results of a study by investigators at Johns Hopkins and other institutions.
A Roman philosopher was the first to note the relationship between a sound mind and a sound body. Now the findings of a new Johns Hopkins study reveal a possible biochemical explanation behind this ancient observation.
Johns Hopkins researchers have developed a sugar-based molecular microcapsule that eliminates the toxicity of an anticancer agent developed a decade ago at Johns Hopkins, called 3-bromopyruvate, or 3BrPA, in studies of mice with implants of human pancreatic cancer tissue. The encapsulated drug packed a potent anticancer punch, stopping the progression of tumors in the mice, but without the usual toxic effects.
Using an ultrasensitive blood test to detect the presence of a protein that heralds heart muscle injury, researchers from Johns Hopkins and elsewhere have found that obese people without overt heart disease experience silent cardiac damage that fuels their risk for heart failure down the road.
The following research findings were presented by Johns Hopkins cardiologists at the annual Scientific Sessions Meeting of the American Heart Association in Chicago.
For years, a multidisciplinary team of Johns Hopkins researchers has tracked an elusive creature, a complex of proteins thought to be at fault in some cases of sudden cardiac death. As they report Nov. 5 in the online edition of Nature Communications, they have finally captured images of the complex. Those images reveal the connection between some genetic mutations and electrical abnormalities of the heart and provide a starting point for designing therapies.
Heart attack survivors often experience dangerous heart rhythm disturbances during treatment designed to restore blood flow to the injured heart muscle, a common and confounding complication of an otherwise lifesaving intervention
Bruce A. Perler, M.D., M.B.A., was named president-elect of the Society for Vascular Surgery, an international medical society with 5,000 members, at the society’s recent annual meeting in Boston.
A new Johns Hopkins review of 20 years’ worth of published research suggests that risks linked to long-term use of statins, including muscle toxicity, diabetes and dementia, are very low and that the potential benefit is very high. And although some experts say statins may be overprescribed, the new analysis could provide reassurance of the relative safety of the cholesterol-lowering drugs for the more than 200 million people worldwide who take them.
Studies by vascular biologists at The Johns Hopkins Hospital could lead to new treatments for vascular disease. This work was led by Dan Berkowitz, M.B.B.Ch., and Lewis Romer, M.D., both professors of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine. The studies focus on the balance between (good) nitric oxide, and (bad) oxidants—both important regulators of the inner lining of blood vessels, called the endothelium.
Researchers at Johns Hopkins have spotted a strong family trait in two distant relatives: The channels that permit entry of sodium and calcium ions into cells turn out to share similar means for regulating ion intake, they say. Both types of channels are critical to life. Having the right concentrations of sodium and calcium ions in cells enables healthy brain communication, heart contraction and many other processes. The new evidence is likely to aid development of drugs for channel-linked diseases ranging from epilepsy to heart ailments to muscle weakness.
By analyzing the number of times scientists were cited in others’ papers, the company Thomson Reuters has created a new list of the top 3,215 most highly cited—and therefore most influential— researchers in the world. Seventeen are from the Johns Hopkins University School of Medicine.
A genetic variant linked to sudden cardiac death leads to protein overproduction in heart cells, Johns Hopkins scientists report. Unlike many known disease-linked variants, this one lies not in a gene but in so-called noncoding DNA, a growing focus of disease research. The discovery, reported in the June 5 issue of The American Journal of Human Genetics, also adds to scientific understanding of the causes of sudden cardiac death and of possible ways to prevent it, the researchers say.
New animal studies by Johns Hopkins cardiovascular researchers strongly suggest that sildenafil, the erectile dysfunction drug sold as Viagra and now under consideration as a treatment for heart failure, affects males and females very differently.
Traditional first-line checks of such heart disease risk factors as cholesterol, blood pressure and smoking habits aren’t nearly good enough to identify cardiovascular disease in otherwise healthy, young firefighters, according to results of a small Johns Hopkins study.
A type of cell that builds mouse hearts can renew itself, Johns Hopkins researchers report. They say the discovery, which likely applies to such cells in humans as well, may pave the way to using them to repair hearts damaged by disease — or even grow new heart tissue for transplantation.
Men with long-term HIV infections are at higher risk than uninfected men of developing plaque in their coronary arteries, regardless of their other risk factors for coronary artery disease, according to results of a study led by Johns Hopkins researchers. A report on the research appears in the April 1 issue of Annals of Internal Medicine.
In a study that began in a pair of infant siblings with a rare heart defect, Johns Hopkins researchers say they have identified a key molecular switch that regulates heart cell division and normally turns the process off around the time of birth. Their research, they report, could advance efforts to turn the process back on and regenerate heart tissue damaged by heart attacks or disease.
Johns Hopkins pediatric cardiologist and geneticist Hal Dietz, M.D., has been awarded the first Harrington Prize for Innovation in Medicine for his work identifying the cause and a treatment for Marfan syndrome.
Study Shows Value of Calcium Scan in Predicting Heart Attack and Stroke Among Those Considered at ...
A new study shows that coronary artery calcium (CAC) screening, an assessment tool that is not currently recommended for people considered at low risk, should play a more prominent role in helping determine a person's risk for heart attack and heart disease-related death, as well as the need for angioplasty or bypass surgery. CAC screening provides a direct measure of calcium deposits in heart arteries and is easily obtained on a computed tomography (CT) scan.
Johns Hopkins researchers have developed a more accurate way to calculate low-density lipoprotein (LDL) cholesterol, the so-called "bad" form of blood fat that can lead to hardening of the arteries and increase the risk of heart attack and stroke. If confirmed and adopted by medical laboratories that routinely calculate blood cholesterol for patients, the researchers say their formula would give patients and their doctors a much more accurate assessment of LDL cholesterol.
A Johns Hopkins undergraduate biomedical engineering student team that devised a two-part system to improve the way life-saving shocks are delivered to hearts earned first-prize in the undergraduate division of a national Collegiate Inventors Competition. In the graduate-level competition, Isaac Kinde, a Johns Hopkins medical student, received third-place honors for developing a test to detect ovarian and endometrial cancers as part of a team at the Johns Hopkins Kimmel Cancer Center.
A new study highlights the importance of exercise and physical fitness among people with stable coronary artery disease. Researchers at the Johns Hopkins University School of Medicine and Henry Ford Hospital found that higher levels of physical fitness lower the risk of having heart attacks and increase survival in those with coronary artery disease, whether or not they have had a procedure to open up their blocked arteries.
A review of dozens of studies on the use of statin medications to prevent heart attacks shows that the commonly prescribed drugs pose no threat to short-term memory, and that they may even protect against dementia when taken for more than one year. The Johns Hopkins researchers who conducted the systematic review say the results should offer more clarity and reassurance to patients and the doctors who prescribe the statin medications.
Johns Hopkins researchers, working with mice, say they have identified a chemical compound that reduces the risk of dangerous, potentially stroke-causing blood vessel spasms that often occur after the rupture of a bulging vessel in the brain.
Johns Hopkins Medicine has teamed up with a local philanthropic foundation to provide automated external defibrillators (AEDs), to 10 Baltimore City middle schools for use, if needed, during sporting events and practices. The portable devices, which are used to shock the heart back into a normal rhythm, can save the life of a student athlete, coach or spectator who collapses during practice or a game due to a heart rhythm disorder that causes sudden cardiac arrest.
Irene Pollin, a passionate health advocate and founder of a national organization devoted to heart disease prevention in women, has made a $10 million gift to the Ciccarone Center for the Prevention of Heart Disease. Her donation also establishes the Kenneth Jay Pollin Professorship in Cardiology and will launch pivotal research on heart disease prevention.
A large, multi-center study led by Johns Hopkins researchers has found a significant link between lifestyle factors and heart health, adding even more evidence in support of regular exercise, eating a Mediterranean-style diet, keeping a normal weight and, most importantly, not smoking.
In what promises to be an eye-opener for many doctors and patients who routinely depend on cholesterol testing, a study led by researchers at the Johns Hopkins University School of Medicine found that the standard formula used for decades to calculate low-density lipoprotein (LDL) cholesterol levels is often inaccurate.
In a study of the impact of weight loss on reversing heart damage from obesity, Johns Hopkins researchers found that poor heart function in young obese mice can be reversed when the animals lose weight from a low-calorie diet.
An abdominal aortic aneurysm - a bulge in the large artery that carries blood away from the heart - can be immediately life-threatening if it grows large enough to rupture.
Researchers have found a genetic variant that doubles the likelihood that people will have calcium deposits on their aortic valve.
Researchers at the Johns Hopkins University School of Medicine and Sanford-Burnham Medical Research Institute in California have created a laboratory-grown cell model of an inherited heart condition known as arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C).
The Johns Hopkins Heart and Vascular Institute will hold the very popular “Heartfest” on Saturday, Jan. 19, 2013.
Research by Johns Hopkins cardiologists suggests that electrocardiograms (ECGs) may have a greater and more profound future role in predicting the risk of death from any cause, not just heart problems.
Women who go into early menopause are twice as likely to suffer from coronary heart disease and stroke, new Johns Hopkins-led research suggests.
The Johns Hopkins Cardiac Rehabilitation Program at Green Spring Station has received national certification from the American Association of Cardiovascular and Pulmonary Rehabilitation, a designation that recognizes excellent care and the most advanced practices in cardiac rehabilitation. The certification, which is for three years, followed an intensive process of collecting and analyzing data on a wide range of patient outcomes and demonstrating the program’s adherence to the most current standards and guidelines.