The Rhythm | Issue 5
Issue 5 | Week of 4 May 2026
Heart Rhythm 2026 closed in Chicago on 26 April. This issue covers one trial from the meeting alongside new publications in the New England Journal of Medicine (NEJM), the Lancet, and the Journal of the American College of Cardiology (JACC).
Cardiology Intelligence Briefing: better questions, better answers
This week brought two practice-changing trials, one consolidating meta-analysis, and two papers that sharpen the tools cardiology uses to generate and apply evidence.
PRAETORIAN-DFT asked a question cardiology has lived with for two decades: does the shock test performed at the end of every subcutaneous implantable cardioverter-defibrillator (S-ICD) implant actually improve outcomes? The answer, in 965 patients, is no. Omitting defibrillation testing (DFT) was non-inferior on first-shock efficacy and produced fewer 30-day complications.1 TRIDENT delivered something rarer: a placebo-controlled outcomes trial in survivors of intracerebral haemorrhage (ICH), a population in whom long-term blood pressure (BP) control has been notoriously hard to achieve. A low-dose three-drug single pill held mean systolic BP 11 mmHg below placebo, and recurrent strokes fell by a third over 2.5 years.2
The Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC) pooled 46 trials and 285,124 participants, more than 59,000 of them with chronic kidney disease (CKD), to ask whether BP lowering still helps when kidney function is severely reduced. It does. Across every CKD stage, including stages 4 and 5, the cardiovascular benefit holds.3
The remaining two papers turn from clinical questions to the architecture of cardiovascular evidence. Misra and colleagues advanced a clinical polygenic risk score (PRS) covering eight conditions through external validation in 53,306 biobank participants, a step closer to routine reporting in US health systems.4 Batchelor and colleagues quantified fifteen years of regulatory stent trial enrolment: minority and women patients have stayed below the field's own adequacy thresholds, and only one of those gaps is fixable by site selection.5
Together, the five papers question old practice, supply missing randomised evidence, and audit the evidence base itself. Better questions, better answers.
