Background: Atrial Fibrillation (AF) affects 10.5 million adults in the US and is projected to reach 12.1 million by 2030, representing a growing burden. We evaluated predictors of 30‐day readmission after electrical cardioversion (EC) for AF. Methods: In this retrospective observational cohort study using the Nationwide Readmissions Database (2016–2017), we identified adults with AF undergoing EC. Outcomes evaluated were 30‐day all‐cause readmission, in‐hospital mortality, length of stay (LOS) and inflation‐adjusted hospitalization charges. Multivariable logistic regression identified predictors of 30‐day readmission. Results: Among 134 114 AF hospitalizations managed with EC, 13 260 (9.9%) were readmitted within 30 days. Readmitted patients (mean age 70, 51% male) had longer index stays (4 vs. 3 days), higher charges ($31 576 vs. $26 896), and more frequent nonhome discharges (11% vs. 6.4%; all p < 0.001). Readmissions added $27 994 in costs. In‐hospital mortality was higher during readmission (2.9% vs. 0.7%). Independent predictors included female sex, Medicaid or Medicare coverage, and chronic pulmonary disease, hypertension, diabetes and heart failure (HF) ( p < 0.001). Higher median household income was associated with lower odds of readmission ( p < 0.001). Conclusion: Nearly 1 in 10 AF patients treated with EC was readmitted within 30 days. Female sex, comorbidity burden and lower socioeconomic status were key predictors. Improved post‐discharge care addressing comorbidities alongside rhythm management may reduce early readmissions.

Background/Objectives: Drowning is a leading preventable cause of unintentional injury death, yet U.S. prevention efforts have largely focused on children. Despite international declines in pediatric drowning mortality, adult trends remain poorly characterized. We examined long-term trends and disparities in unintentional drowning mortality among U.S. adults aged ≥25 years from 1999 to 2024. Methods: Using CDC WONDER Multiple Cause of Death data, drowning deaths were identified using ICD-10 codes W65–W74, V90, and V92. Age-adjusted mortality rates (AAMRs) per 100,000 were computed by direct standardization to the 2000 U.S. standard population. Joinpoint regression estimated the annual percent change (APC) and average annual percent change (AAPC). Three sensitivity analyses assessed transport-related code exclusion, pandemic-era restriction, and multiple cause-of-death coding. Results: During 1999–2024, 101,743 unintentional drowning deaths occurred among U.S. adults aged ≥25 years (76,554 males; 25,201 females), with 58.09% in natural water or outdoor settings. The overall AAMR showed a non-significant increase (AAPC: 0.55%, p = 0.054); however, joinpoint analysis identified stable rates through 2013 followed by a significant sustained increase (APC: 1.32%, 95% CI: 0.32–2.32, p = 0.012). The male-to-female rate ratio narrowed significantly from 4.00 (1999) to 3.32 (2024) (ratio of rate ratios: 0.83, p = 0.0006), driven by a sustained female increase (AAPC: 1.27%, p < 0.001). Adults aged 65–85+ showed the steepest rise (AAPC: 1.15%, p < 0.001). Non-Hispanic AI/AN adults had the highest rates (3.47–5.44 per 100,000), and non-metropolitan areas consistently exceeded metropolitan rates. Conclusions: A significant upward trajectory has persisted since 2013, with marked disparities by age, sex, race/ethnicity, and geography. Adult-focused, equity-driven prevention strategies aligned with USNWSAP implementation are needed to address this underrecognized burden.

Background: Tirzepatide, a dual GIP/GLP-1 receptor agonist, demonstrates substantial glycemic and weight benefits versus GLP-1 receptor agonists in indirect comparisons, but direct comparative safety evidence versus dulaglutide remains limited. We evaluated comparative safety (primary outcome: overall adverse events) and efficacy. Methods: Following PRISMA 2020 (prospectively registered: PROSPERO CRD420251276594), we searched MEDLINE, Embase, Scopus, and CENTRAL (inception–31 December 2025) for randomized controlled trials (≥26 weeks) comparing once-weekly tirzepatide with dulaglutide in adults with type 2 diabetes. Three trials (N = 13,590 participants) were included. Dichotomous outcomes were pooled using random-effects models (risk ratios [RRs], 95% confidence intervals [CIs]). GRADE assessed certainty of evidence. Results: Overall adverse event incidence did not differ significantly (RR 1.04 [0.98–1.10]; I² = 36%; moderate-certainty evidence). Discontinuation due to adverse events was consistently higher with tirzepatide (RR 1.32 [1.20–1.45]; I² = 0%; high-certainty evidence), representing a 32% increased risk across all populations. Categorical HbA1c target achievement was analyzed in two trials; the third trial reported HbA1c as a continuous outcome only. At the primary threshold (HbA1c < 7.0%), tirzepatide was consistently superior with no heterogeneity (RR 1.48 [1.33–1.64]; I² = 0%; p < 0.00001). Across all thresholds combined, heterogeneity was extreme (I² = 92%), limiting confidence in any pooled summary estimate; the greatest instability occurred at the strictest threshold (HbA1c < 5.7%; I² = 98%; p = 0.40). Tirzepatide showed greater HbA1c target attainment in treatment-naive patients receiving dulaglutide 0.75 mg, whereas the glycemic advantage was smaller in patients with established cardiovascular disease receiving dulaglutide 1.5 mg. Categorical weight-loss outcomes were analyzed in two trials; tirzepatide was associated with greater weight-loss threshold achievement (RR 8.80 [4.04–19.17]; very low-certainty evidence), although interpretation is limited by substantial heterogeneity and restricted generalizability. Serious adverse events were not significantly different (RR 0.82 [0.47–1.43]; I² = 42%). Conclusions: Overall adverse events were similar between treatments, but tirzepatide consistently increased discontinuation risk, indicating a clinically important tolerability-persistence trade-off. Glycemic efficacy was highly population-dependent: benefits were consistent at the primary HbA1c target (<7.0%; I² = 0%) in early-stage disease, whereas the advantage was smaller in long-standing disease with established cardiovascular disease. Tirzepatide may be favored when glycemic or weight efficacy is prioritized in earlier-stage disease, provided tolerability is proactively managed. Dulaglutide remains appropriate when persistence is threatened by tolerability concerns or cardiovascular risk reduction is the primary goal.

Background: Atrial fibrillation (AF) and respiratory failure (RF) frequently co‐occur in critically ill patients, but long‐term national trends in deaths recording both remain unknown. Methods: CDC WONDER multiple‐cause‐of‐death data identified U.S. adults aged ≥ 55 years with both AF (including atrial flutter) and RF listed on death certificates from 1999 to 2024. Age‐adjusted mortality rates (AAMRs) and annual percent changes (APCs) were estimated using joinpoint regression. Sensitivity analyses included adults aged ≥ 25 years, exclusion of COVID‐19‐related deaths, and stratification by co‐listed heart failure (HF). Results: A total of 462 284 deaths listed both AF and RF. The AAMR increased roughly five‐fold (7.84 to 41.76 per 100 000), rising steadily through 2018 (APC 7.81), accelerating through 2021 (APC 18.78), and declining thereafter (APC −5.90). Excluding deaths listing COVID‐19, the 2018–2021 acceleration was not detected, and AAMRs rose through 2024 (2017–2024 APC 5.25). AAMRs for deaths without HF recorded rose over fourfold. Mean AAMRs were higher in males (26.19) than in females (19.04) and in non‐Hispanic (NH) White adults (24.06) than in other groups. The West and nonmetropolitan areas had the highest rates. The 2018–2021 surge was steepest among Hispanic (APC 25.62) and NH Black adults (APC 24.06). Conclusions: Population mortality rates for deaths recording both AF and RF increased substantially over 25 years, beginning before the COVID‐19 pandemic, persisting after excluding deaths listing COVID‐19, and occurring with and without HF recorded. These data cannot separate changes in disease occurrence from changes in diagnosis or coding.