Tuesday, May 20, 2025

Americans say benefits of MMR vaccine for children outweigh risks by nearly 5-1

Amid significant US measles outbreak, many do not understand risks

Annenberg Public Policy Center of the University of Pennsylvania

Knowledge of how measles spreads — image:
Percentages of U.S. adults who know various ways that measles can be spread. Source: Annenberg Public Policy Center surveys in April 2024 and April 2025.
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Credit: Annenberg Public Policy Center

The United States is in the midst of the second-highest year of measles cases since 2000, when the disease was declared eliminated in this country, meaning that cases within the United States originated outside the country. As of May 8, the U.S. Centers for Disease Control and Prevention (CDC) reported that in 2025, there have been over a thousand confirmed U.S. cases of measles and three confirmed deaths from measles. Because many cases go unreported, this number is considered an undercount. In contrast to the current outbreak, from the time the United States declared that measles was no longer endemic through last year (2000-2024), there’s been an average of about 180 measles cases a year.

While many Americans know how measles can spread, most cannot accurately estimate the prevalence of complications associated with measles such as hospitalization or the risks it presents during pregnancy, according to the latest Annenberg Science and Public Health (ASAPH) survey, which was conducted among 1,653 empaneled U.S. adults from April 15-28, 2025, by the Annenberg Public Policy Center (APPC) of the University of Pennsylvania.

The survey finds that more than 8 in 10 Americans (83%) are not worried that they or someone in their family will contract measles over the next three months. “Since the overwhelming number of individuals in this country, including children, either have had measles or have been vaccinated against it, it is unsurprising that few are worried about getting the virus,” said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center and of the survey. “But with measles cases reported in 31 states and vaccination rates dropping, everyone should be knowledgeable about the symptoms, treatment, and the prevention of measles through the highly effective MMR (measles, mumps, and rubella) vaccine.”

The two doses of the measles vaccine – which are recommended at ages 12-to-15 months for the first dose and 4 to 6 years old for the second dose – are 97% effective at preventing measles among those who are vaccinated and exposed to it, the CDC reports.

Highlights

The Annenberg Public Policy Center’s April 2025 health survey finds that:

Two-thirds of U.S. adults (67%) know that it’s false to say vaccines given to children, like the MMR (measles, mumps, and rubella vaccine), cause autism – but the number who know this is false declined significantly, from 74% in 2021.
Americans overwhelmingly say the benefits of the MMR vaccine for children outweigh the risks (83% to 17%).
Many more Americans (70%) think healthy children should be required to be vaccinated to attend public school because of the potential risk to others who are not vaccinated than think it should be a matter of parental choice (18%).
Most Americans know the most common ways measles can be spread, but about half are not sure how common complications are – or what the risks are during pregnancy.

Preventing measles with the MMR vaccine

Although decades of research have established that the childhood vaccine for measles, mumps, and rubella (MMR) is the best way to protect against measles, some parents are hesitant to have their children vaccinated, in part because of the debunked claim that the MMR vaccine can cause autism. Two-thirds of Americans (67%) say the purported link between MMR and autism is a false one. While the proportion who say the MMR vaccine does not cause autism is sizeable, it is significantly lower than the 74% who said so in June 2021, when the ASAPH survey first asked this question. In the current survey, 1 in 7 people (14%) say it is true that the MMR vaccine causes autism, an increase of 5 percentage points from June 2021 (9%).

To most Americans, the benefits of the MMR vaccine for children outweigh the risks by a wide margin (83% vs. 17%). However, the percentage of Americans who believe the benefits outweigh the risks has dropped slightly but significantly from August 2023, when 89% said the benefits outweighed the risks. Further, 81% say it is true that medical professionals recommend that those who are able to be safely vaccinated take the MMR vaccine even if their chances of exposure are low. This proportion is significantly higher compared to April 2024, when 74% said this was true.

Most agree on vaccine requirements for children to attend public school

When asked about their views on MMR vaccine requirements for children attending school, vastly more people agree that healthy children should be required to be vaccinated to attend public school because of the potential risk to others who are not vaccinated (70%) than say parents should be able to decide, even if it creates risks for others (18%). These results show a significant uptick in support for school vaccine requirements in the 20 months since August 2023 (63%), and a significant decline among those supporting parental choice (22% in August 2023).

Measles risks during pregnancy not widely understood

For people who are pregnant and have not had the MMR vaccine, getting measles can lead to serious complications, such as delivering a low-birth weight baby and early delivery. When asked to select among a list of complications that could occur in someone with measles who is pregnant, a third of survey respondents correctly identify delivering a low birthweight baby (34%) or experiencing an early delivery (34%) as complications of having measles while pregnant. More people identify death as a possible complication this year (16%, significantly more than the 12% last year). A small number of people incorrectly indicate that diabetes (7%) and blurred vision (11%) are more likely to occur if you have measles while pregnant. They are not. Most Americans (57%) say they are not sure what the complications are.

The CDC recommends measles vaccination before but not during pregnancy for those who are unvaccinated; however, only 15% know this. The CDC notes: “Even though MMR is a safe and effective vaccine, there is a theoretical risk to the baby. This is because it is a live vaccine, meaning it contains a weakened version of the living viruses.” The CDC recommends the MMR vaccine be given a month or more before someone becomes pregnant, if that person was not already vaccinated against measles, mumps, and rubella.

Most know how measles spread, but few grasp risks

Amid the current measles outbreak, nearly 6 in 10 (58%) say there are more measles cases in the U.S. than in the comparable period last year. More than a quarter (27%) indicate that they are not sure whether there are more cases than last year, 5% think there are fewer cases, and 11% say the number of cases is about the same.

More people know how measles spreads: Most Americans can identify common ways measles spreads. Two-thirds (66%) correctly say that measles can be spread by touching a contaminated surface and then touching one’s nose, mouth, or eyes, a significant increase from last April when 59% indicated this as a means of spreading measles. Slightly fewer Americans (63%) correctly say that measles can be spread by coughing or sneezing, no statistical difference from last year.

Few know the measles incubation period: Very few of those surveyed know how long a person infected with measles can spread the virus before developing the signature measles rash. One in 7 (14%) correctly estimate that a person can spread the infection for four days before developing a rash, while 12% estimate that the period is one week. The majority of people (55%) report not being sure. These results are unchanged from April 2024.

Few accurately estimate symptoms and complications: Although a majority of respondents know common ways that measles can spread, about half of Americans express uncertainty about how often certain complications occur – and only a small percentage can accurately estimate them. Accuracy was determined for these symptoms if the respondent estimated the incidence within a range of ± 4 percentage points of the actual CDC incidence.

Respondents were asked to estimate the number of people who would experience specific symptoms and complications out of 100 people with measles.

Hospitalization. The CDC reports that about 13% of people who got measles in 2025 were hospitalized, but just over 1 in 8 Americans (13%) estimate this incidence correctly. A third (33%) say they are not sure about the incidence and the remainder either overestimate (36%) or underestimate (17%) the incidence of those with measles who will become hospitalized. This represents no significant change from 2024.
Diarrhea. According to the CDC, about 1 in 10 people who become infected with measles will experience diarrhea as a result. Fifty-four percent of Americans are not sure how many people out of 100 with measles would experience diarrhea, a significant increase in uncertainty of 6 percentage points since April 2024, when we last asked this question (48% unsure). Four percent estimate accurately, 33% overestimate the incidence (down significantly from 40% last year), and 7% underestimate the number.

Beliefs about non-vaccine treatments for measles

Visiting Texas during the measles outbreak in March of this year, U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. said in a Fox News interview that doctors were getting positive results by treating measles with, among other things, cod liver oil, which contains “high concentrations of vitamin A and vitamin D.” Health experts grew concerned that the emphasis on vitamin A could be misheard to suggest that vitamin A could prevent the disease among those exposed to it. However, experts on infectious diseases emphasize that vitamin A cannot prevent someone from getting measles. And a recent New York Times story reports that Texas physicians treating measles patients say they have cared for “a handful of unvaccinated children who were given so much vitamin A that they had signs of liver damage.” (See our project FactCheck.org’s report on Kennedy’s recent, misleading statements about measles.)

The ASAPH survey asked about vitamin A and cod liver oil as a preventive measure against measles and found that a plurality says that taking a daily dose of vitamin A (46%) or a large amount of cod liver oil each day (47%) has no effect on whether one will get measles. An equal number are unsure about the effectiveness of each (45% and 48%, respectively). Just 9% say taking vitamin A daily helps protect one against getting measles and just 4% say taking large amounts of cod liver oil each day would do the same.

As for the general health benefits of taking a large amount of cod liver oil every day, 48% say they are unsure whether there are any health benefits or not. Just as many say cod liver oil improves a person’s health (16%) as say it harms (15%) one’s health. (A 2024 study suggests that fish oil supplements “might be a risk factor” among healthy people for atrial fibrillation and stroke.) A fifth (22%) say taking large amounts of cod liver oil every day has no effect on one’s health one way or the other.

The ASAPH survey

The survey data come from the 24th wave of a nationally representative panel of 1,653 U.S. adults, first empaneled in April 2021, conducted for the Annenberg Public Policy Center by SSRS, an independent market research company. This wave of the Annenberg Science and Public Health Knowledge (ASAPH) survey was fielded April 15-April 28, 2025. The margin of sampling error (MOE) is ± 3.4 percentage points at the 95% confidence level. All figures are rounded to the nearest whole number and may not add to 100%. Combined subcategories may not add to totals in the topline and text due to rounding.

Download the topline and methodology statement.

The policy center has been tracking the American public’s knowledge, beliefs, and behaviors regarding vaccination, Covid-19, flu, maternal health, climate change, and other consequential health issues through this survey panel for over four years. The APPC team behind this survey includes Ken Winneg, managing director of survey research, who authored this press release and supervised the fielding of the survey, Laura Gibson, who analyzed the data, and Patrick E. Jamieson, director of the Annenberg Health and Risk Communication Institute, who developed the questions.

Graphic shows that few U.S. adults accurately estimate the incidence of hospitalization and diarrhea in people who are infected with measles. Source: Annenberg Public Policy Center surveys in April 2024 and April 2025.

Credit

Annenberg Public Policy Center

###

See other recent Annenberg health knowledge surveys:

Alcohol and cancer: Awareness grows of cancer risk from alcohol consumption (April 1, 2025)
Raw milk and bird flu: With bird flu in raw milk, many still do not know risks of consuming it (March 14, 2025)
Firearm safety: Over 1 in 3 adults in households with guns do not store all in locked locations (March 11, 2025)
Low-dose aspirin: Nearly half of adults mistakenly think benefits of daily aspirin outweigh risks (Feb. 3, 2025)
Vaccination mandates: Most Americans favor school vaccination requirements, but support is rising for opt-out options (Jan. 28, 2025)

The Annenberg Public Policy Center was established in 1993 to educate the public and policy makers about communication’s role in advancing public understanding of political, science, and health issues at the local, state, and federal levels.

Method of Research

Survey

New breakthrough in kraft lignin for enhanced wet-strength in molded pulp materials

Sustainable wet-strength solutions for eco-friendly packaging

Journal of Bioresources and Bioproducts

New Breakthrough in Kraft Lignin for Enhanced Wet-Strength in Molded Pulp Materials — image:
Sustainable Wet-Strength Solutions for Eco-Friendly Packaging
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Credit: RISE PFI AS, Trondheim NO-7491, Norway

In a groundbreaking study published in the Journal of Bioresources and Bioproducts, researchers Eva Pasquier and Jost Ruwoldt from RISE PFI AS in Norway have demonstrated that Kraft lignin can significantly enhance the wet-strength and stiffness of molded pulp materials. This development paves the way for sustainable alternatives to traditional plastic packaging, addressing the growing need for environmentally friendly solutions.

The study investigates the use of Kraft lignin as a wet-strength agent in bleached kraft pulp, which is then thermopressed into materials with potential applications in packaging. The researchers found that adding Kraft lignin, along with retention aids such as cationic starch or flocculants, significantly improved the mechanical properties of the molded pulp. The results showed that pressing the materials at elevated moisture levels further enhanced their wet strength, achieving up to 9 MPa in tensile tests. Additionally, the wet stiffness of the substrates increased from 200 to 938 MPa, without compromising elongation or causing embrittlement.

The study also explored the impact of lignin particle size and the type of flocculant used. The results indicated that while lignin nanoparticles provided better dispersion and homogeneity, the overall strength was more influenced by the moisture content during pressing. The researchers concluded that the high moisture content facilitated the plasticization of lignin at high temperatures, leading to a stronger cellulose-lignin network after cooling.

This research highlights the potential of Kraft lignin as a sustainable and effective wet-strength agent for molded pulp materials. By optimizing parameters such as moisture content and lignin particle size, the study offers a foundation for developing new, eco-friendly packaging solutions that can replace plastics while maintaining recyclability and biodegradability.

See the article:

DOI

10.1016/j.jobab.2025.05.001

Original Source URL

https://www.sciencedirect.com/science/article/pii/S2369969825000337

Journal

Journal of Bioresources and Bioproducts

Journal

Journal of Bioresources and Bioproducts

DOI

10.1016/j.jobab.2025.05.001

Method of Research

Experimental study

Subject of Research

Not applicable

Article Title

Kraft Lignin as Wet-Strength and Wet-Stiffness Additives for Molded Pulp Materials

Article Publication Date

19-May-2025

International cooperation needed for healthy sustainable diets

Research team identifies global gaps in national food self-sufficiency

University of Göttingen

Map showing self-sufficiency in food of different countries — image:
Only one country – Guyana (shown in khaki green on the map) – is self-sufficient in all seven food groups. The majority of countries (three out of five) do not produce sufficient food domestically in at least four out of seven food groups essential for a healthy, sustainable diet. This means they are vulnerable to breaks in supply caused by war, natural disasters or trade disagreements, for instance.
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Credit: Photo: Jonas Stehl, with data published in Nature Food 2025, DOI: 10.1038/s43016-025-01173-4

Growing emphasis on self-reliance and trade barriers could impair the ability of people to consume healthy and sustainable diets around the world. Research teams from the University of Göttingen and the University of Edinburgh investigated the extent to which 186 countries can feed their own populations solely through domestic production. The study was published in the journal Nature Food.

The researchers evaluated seven food groups that are part of the World Wildlife Fund’s Livewell diet. Only one in seven countries achieve self-sufficiency in five or more essential food groups – most within Europe and South America. This lack of self-sufficiency was especially true in the Caribbean, West Africa, and the Gulf states. Six countries, primarily in the Middle East, do not produce enough of a single food group for their own needs.

Notably, only Guyana achieved complete self-sufficiency in all seven food groups, while China and Vietnam nearly reach this by achieving six. Significant discrepancies exist regarding self-sufficiency in meat and dairy products. For example, while several European countries produce far in excess of their needs, domestic production in African countries is very low. The Democratic Republic of the Congo, for instance, produces only about 15% of its requirements for meat. The analysis uncovers shortfalls in nutrient-dense plant protein worldwide: fewer than half of the countries achieve their domestic needs for legumes (for instance, beans and peas), or nuts and seeds, while only a quarter do so for vegetables.

The study additionally highlights that some countries have low production and simultaneously rely almost exclusively on a single trading partner for more than half of their imports, compounding their vulnerability. This pattern is especially pronounced in smaller countries, including island states. Similarly, many Central American and Caribbean countries depend on the United States for the bulk of their imports of starchy staples – for instance, wheat and maize – and several European and Central Asian countries rely on a single partner for legumes, nuts and seeds.

“International food trade and cooperation is essential for healthy and sustainable diets. However, heavy reliance on imports from single countries can leave nations vulnerable,” says Jonas Stehl, PhD researcher at the University of Göttingen and first author of the study. “Building resilient food supply chains is imperative for ensuring public health.”

This research was financially supported by the European Centre for Advanced Studies (ECAS).

Original publication: Jonas Stehl et al. “Gap between national food production and food-based dietary guidance highlights lack of national self-sufficiency”, Nature Food 2025, DoI: 10.1038/s43016-025-01173-4

Journal

Nature Food

DOI

10.1038/s43016-025-01173-4

Method of Research

Systematic review

Subject of Research

Not applicable

Article Title

Gap between national food production and food-based dietary guidance highlights lack of national self-sufficiency

Article Publication Date

16-May-2025

Seawater microbes are a powerful tool for diagnosing coral reef health and strengthening conservation efforts, according to new paper

Woods Hole Oceanographic Institution

Collection of water to analyze microorganisms — image:
Collection of water for analyzing reef water microorganisms is routinely done in St. John, USVI, using a Niskin bottle, which can be closed underwater at the sampling location.
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Credit: Photo by Amy Apprill, ©Woods Hole Oceanographic Institution

Woods Hole, MA (May 16, 2025) - Corals everywhere on the planet live in harmony with microscopic organisms. Many corals get their vivid colors from microscopic algae which lives inside the corals’ tissue and provides the coral with food. Even in the water surrounding coral reefs, there is a microscopic soup of bacteria, archaea, and other types of microbes that respond to changes in the habitat and can indicate whether or not the coral reef is healthy.

In a new paper published in Cell Reports Sustainability, authors Amy Apprill, associate scientist in Marine Chemistry & Geochemistry at Woods Hole Oceanographic Institution (WHOI), and Jennifer L. Salerno, marine biologist and associate professor in the Department of Environmental Science and Policy at George Mason University, detail just how valuable these surrounding microbial communities are for coral reef monitoring and conservation. They describe how sampling and analyzing reef water for certain microbes can be useful, not just to microbiologists and reef scientists, but to others directly tasked with managing and conserving reef ecosystems, like marine park managers, conservation non-profits, restoration teams, and policy makers.

“Factoring in microbes is very helpful to understand more about overall reef health,” Apprill said. “My team has produced over a dozen detailed datasets that demonstrate these connections. Our goal with this new paper is to make this knowledge accessible to the programs and people interested in using microbes to diagnose reef health and ocean conditions.”

Compared to taking visual observations of reef habitats, sampling and analyzing water microbes provides a more immediate picture of health and more details about the organisms living alongside the reefs. The paper provides a detailed overview of best approaches, estimated costs, and recommendations for organizations and conservationists to easily apply these techniques.

Bacteria and archaea are the most numerous of the microbes in reef environments. They respond to the surrounding chemical environment, like nutrients and trace elements, as well as physical properties of the water like oxygen saturation, temperature, pH, and light. The presence of specific microbes can indicate certain conditions in the water. For example, the paper states, the presence of E. coli commonly indicates human or animal waste in the nearby environments, often a bad sign for reef health. On the other hand, an abundance of a common photosynthetic microorganism can be a positive sign.

“The utility of using microbes as meaningful indicators is increasing as our understanding of their roles in maintaining or destabilizing health and ecosystem function is growing,” Salerno said. “I think we have the science and accessible technology to take a more nuanced approach to coral reef conservation, management, and policy decisions by deploying diagnostic tools like this.”

Non-invasive water sampling can be done using a variety of approaches, ranging in cost and technical complexity, making it accessible to different stakeholders. Similarly, examining the microorganisms can be done with different methods, also ranging in complexity and cost, from using a compound fluorescence microscope, to extracting DNA and RNA for more detailed data. In the paper, Salerno and Apprill also call for standardizing methods, and for coordination between scientists and organizations to ensure the success of a large-scale monitoring program. They also provide recommendations on ‘where to’ and ‘when to’ sample reef sites based on previous studies and experience.

“Because of the decline of coral reefs and the increased attention towards interventions such as restoration or rebuilding of a reef, it is important to bring all the relevant tools to the table to help restore, manage, and conserve reef ecosystems,” Apprill said.

Knowledge about reef microbial communities, including the abundance of microbes in the water and the microbial community composition and diversity, can provide a diagnostic snapshot of a specific system and, with continued sampling, demonstrate how it changes over time. Ultimately, Apprill and Salerno want this knowledge widely available, accessible, and recorded in open-access data banks. That way, as databases on reef water microorganisms grow, “machine learning-type approaches can be implemented” to provide additional information on microbe-coral reef dynamics and “learned patterns from global data can be used to develop a microbial reef water health index,” the paper states.

“As coral reef scientists, we are very good at monitoring change and sometimes determining the root causes of the changes we are seeing on the reef. We aren't as well versed in mitigation and coordinated responses to emerging threats, but I would say as a community, we are improving,” Salerno said. “If we can become better at predicting emerging threats through the use of diagnostic tools, perhaps we can also become better at preventing them from impacting reefs in the first place. With coral reefs being impacted by climate change globally, it is more important than ever to understand and boost resilience locally.”

The last two years have brought some of the worst coral bleaching events ever recorded—when coral expel their microscopic algae due to heat stress and other environmental factors. As the ocean continues to absorb excess heat from worsening climate change, the future of many coral reef ecosystems are in jeopardy. Having as many solutions and tools to protect these essential marine systems—that host more biodiversity than anywhere else in the ocean—is crucial, Apprill explained.

“We need to provide as much practical and accessible information as we can to the people making decisions,” Apprill said. “I think these microbes can enhance our knowledge of the ecosystem and elevate our framework for decision making. I want people to get excited about this idea, and for current coral reef monitoring programs and management agencies to understand how this can make a difference to their programs.”

Key take-ways:

Microorganisms in the water surrounding coral reefs provide valuable insights on the health state of reefs and surrounding ocean.
Sampling and analyzing reef water microbes can be done in a variety of ways ranging in cost and complexity, adding to their usability.
As many coral reefs experience prolonged bleaching due to heat stress, rising temperatures due to climate change, and other anthropogenic activities, having more accessible monitoring tools can improve coral conservation efforts.
The authors believe that microbe diagnostic techniques can be easily adopted by established organizations to bolster reef monitoring programs and add to a global database of knowledge about coral reef habitats that can inform policy decisions.

Authors:

Amy Apprill, Woods Hole Oceanographic Institution, 266 Woods Hole Road, MS #4, Woods Hole, MA 02543

Jennifer L. Salerno, Potomac Environmental Research and Education Center, Department of Environmental Science and Policy, George Mason University, 650 Mason Ferry Avenue, Woodbridge, VA 22191

A low-cost groundwater pump is deployed above the reef, and then water is pumped to the surface for collection in bottles. The water will be used to examine reef water-associated microorganisms to evaluate the health of the reef environment.
Credit
(Photo by Paul Caiger, ©Woods Hole Oceanographic Institution)

Photo of a coral reef in Jardines de la Reina, Cuba, where reef water microbial sampling has been employed to examine coral reef ecosystem health.

Credit

(Photo by Amy Apprill, ©Woods Hole Oceanographic Institution)

About Woods Hole Oceanographic Institution

The Woods Hole Oceanographic Institution (WHOI) is a private, non-profit organization on Cape Cod, Massachusetts, dedicated to marine research, engineering, and higher education. Established in 1930, its primary mission is to understand the ocean and its interaction with the Earth as a whole, and to communicate an understanding of the ocean’s role in the changing global environment. WHOI’s pioneering discoveries stem from an ideal combination of science and engineering—one that has made it one of the most trusted and technically advanced leaders in basic and applied ocean research and exploration anywhere. WHOI is known for its multidisciplinary approach, superior ship operations, and unparalleled deep-sea robotics capabilities. We play a leading role in ocean observation and operate the most extensive suite of data-gathering platforms in the world. Top scientists, engineers, and students collaborate on more than 800 concurrent projects worldwide—both above and below the waves—pushing the boundaries of knowledge and possibility. For more information, please visit www.whoi.edu

Journal

Cell Reports Sustainability

DOI

10.1016/j.crsus.2025.100403

Method of Research

Experimental study

Subject of Research

Animals

Article Title

Reef water microorganisms as diagnostic indicators for coral reef ecosystem management and sustainability

Article Publication Date

16-May-2025

Two out of five patients with heart failure do not see a cardiologist even once a year and these patients are more likely to die

European Society of Cardiology

If you have cancer, you expect to see an oncologist, but if you have heart failure you may or may not see a cardiologist. According to research published in the European Heart Journal [1] today (Sunday), only around three out of five heart failure patients see a cardiologist at least once a year.

The study, also presented at Heart Failure Congress 2025, shows that patients who do see a cardiologist once a year are around 24% less likely to die in the following year. It also shows which patients could benefit from seeing a cardiologist once a year and which patients should be seen more often.

The research suggests that if cardiologists did see heart failure patients at least once a year, one life could be saved for every 11–16 patients seen.

The study is by a team of French researchers led by Dr Guillaume Baudry and Professor Nicolas Girerd from the Clinical Investigation Centre of Nancy University Hospital.

Dr Baudry said: “In patients with heart failure, the heart is unable to normalise blood flow and pressure. Heart failure can’t usually be cured, but with the right treatment, symptoms can often be controlled for many years. At the moment, depending on the patient and their condition, for example whether they have chronic or acute heart failure, they may or may not be seen by a cardiologist.

“We conducted this study to see whether some simple criteria could be used to divide patients into high or lower risk categories and to assess whether an appointment with a cardiologist is linked with deaths or hospitalisation in heart failure patients at the national level, based on these categories.”

The study included all French patients living with heart failure in January 2020 who had been diagnosed in the previous five years – 655,919 people in total. These patients were found using French national medical administrative data. Researchers broke the group down according to whether they had been hospitalised with heart failure in the last year or the last five years, and whether or not they were taking diuretics as a treatment. Diuretics help the body eliminate excess sodium through urine, which reduces the build-up of fluid in the body.

Among all groups of patients, researchers found that around two out of every five patients did not see a cardiologist over the course of a year. Those who did see a cardiologist were less likely to die of any cause and less likely to be hospitalised with heart failure in the following year.

Taking into account the number of cardiology consultations available at a national level, the researchers created a model to show how often patients should see a cardiologist, based on recent hospitalisation and diuretic use, to reduce the risk of death as much as possible.

According to the model, patients who had not recently been hospitalised and were not taking diuretics, one visit per year would be optimal to minimise the risk of death. This would reduce their risk of dying in the following year from 13% to 6.7%.

Those who had not recently be hospitalised but were taking diuretics, should be seen two to three times per year. This would reduce their risk of death from 21.3% to 11.9%.

In patients who had been hospitalised in the last five years, but not in the last year, being seen two to three times per year appears optimal. This would reduce the risk from 24.8% to 12.9%.

For patients who had been hospitalised in the last year, four appointments with a cardiologist were optimal. This reduced the risk from 34.3% to 18.2%

The researchers caution that the design of the study (a retrospective observational study) means they cannot be certain that seeing a cardiologist leads to a lower risk of death, only that the two are associated. Although they made every attempt to account for other factors, it could be that patients under the care of cardiologists have had a lower risk of dying for some other reason.

Dr Baudry said: “Although there are inherent limitations in observational research, our findings highlight the potential value of specialist follow-up, even in patients who appear clinically stable. Patients should feel encouraged to ask for a cardiology review, particularly if they have recently been in hospital or they are taking diuretics.”

Professor Girerd added: “There could be many reasons why heart failure patients do not see a cardiologist, for example, we know that older people and women are less likely to see a cardiologist. We found that patients with another chronic condition, such as diabetes or a lung condition, were also less likely to see a cardiologist. These differences have been found in many countries around the world.

“Our findings suggest that referrals to cardiology could be made more systematically in heart failure care, in the same way that an oncology referral is part of routine cancer care.

“We have also found that that two very simple criteria – recent hospitalisation and diuretic use – can easily stratify patient risk. These criteria don’t involve any expensive tests, so can be used by anyone, in any setting, in any country. These results could help redesign health systems to reduce deaths while preserving resources.”

The researchers are now planning to test their findings in an interventional clinical trial. They also hope to study the impact of seeing a cardiologist for heart failure in other countries with different healthcare systems.

In an accompanying editorial [2] Professor Lars Lund from the Karolinska Institutet, Stockholm, Sweden said: “Since the first heart transplantation in 1967, drug discovery, technology advances, and rigorous randomised clinical trials have delivered extensive and highly effective evidence-based and guideline-directed medical therapy and other interventions for heart failure. Yet patients are not receiving and benefiting from these treatments. Consequently, outcomes in heart failure are not improving.

“…the present French study adds important evidence that for patients with heart failure, regardless of severity, access to cardiology follow-up is associated with improved use of guideline-directed medical therapy and improved outcomes. Yet, in many countries, there is a continued push to triage patients with heart failure away from cardiology and toward primary care which is often overburdened and cannot be expected to master the complexities of heart failure treatment selection and optimisation. Heart failure is common and serious, but treatable. What good is 50 years of discovery, innovation, and rigorous randomised-controlled trials delivering highly effective therapy, if this therapy is not used?”

In a second presentation at Heart Failure Congress 2025 on the same cohort [3], the researchers discussed sex differences in outcome and healthcare utilisation. After adjusting for demographic differences, they found that 33.8% of women did not see a cardiologist within a year while in men, the proportion was 27.9%. Women were also less likely to be prescribed RAS inhibitors, which act to lower blood pressure. Despite these differences, women had better outcomes than men in term of mortality and heart failure events.

Journal

European Heart Journal

DOI

10.1093/eurheartj/ehaf218

Method of Research

Observational study

Subject of Research

People

Article Title

Cardiologist follow-up and improved outcomes of heart failure: a French nationwide cohort

Article Publication Date

18-May-2025

COI Statement

G.B. reports personal fees from Abbott, AstraZeneca, Boehringer Ingelheim and Novartis, outside the submitted work. F.R. reports grants from Air Liquide and Abbott, outside the submitted work; consulting fees from Abbott, Air Liquid, Bayer, and Pfizer; lectures fees from AstraZeneca, Servier, Boerhinger Ingelheim, Vifor, Bayer, Novartis, Novonordisk, Air Liquid, Abbott, and QuidelOrtho; travel fees from Novartis and Boerhinger Ingelheim; participation on a data safety monitoring board or advisory board for Carmat; and part of Boehringer Ingelheim, Vifor Pharma, and Novartis board. T.D. reports grants from Pfizer outside the submitted work, consulting fees from Pfizer, lecture fees from Pfizer, and travel fees from Pfizer. N.G. reports personal fees from AstraZeneca, Bayer, Boehringer, Novartis and Vifor outside the submitted work. All other authors have nothing to disclose.