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Article History

Received: 1 July 2025

Accepted: 17 March 2026

First Online: 4 April 2026

Competing interests

: Dr. Sawano has received partial research funding through Yale University from PolyBio, Pfizer, and Norvatis. He has also received lecture honoraria from Boehringer Ingelheim and Abbott and receives compensation for his role as Execute Associate Editor for JACC, all outside the scope of this work. Dr. Nishimura received support from the National Institute of General Medical Sciences of the National Institute of Health. Dr. Khera is an associate editor at JAMA; and has received support from the National Institutes of Health (awards R01 AG089981, R01 HL167858 and K23 HL153775) and the Doris Duke Charitable Foundation (award 2022060); has received research support, through Yale University, from Bristol Myers Squibb, Novo Nordisk, and BridgeBio; is a coinventor of U.S. provisional patent applications WO2023230345A1, US20220336048A1, 63/177,117, 63/346,610, 63/428,569, 63/484,426, 63/508,315, 63/580,137, 63/606,203, 63/619,241, and 63/562,335, unrelated to the present work; and is a cofounder of Evidence2Health and Ensight-AI, precision health platforms to improve evidence-based cardiovascular care and cardiovascular diagnostics. Dr. Thangaraj is a coinventor on provisional patent 63/606,203, unrelated to the present work, and is funded by grant 5T32 HL155000-03. Ms. Blacketer, Dr. Ostropolets, Dr. Schuemie, and Dr. Ryan are employees of Johnson & Johnson and shareholders of Johnson & Johnson. Ms. Li and Ms. Yin are employees of IQVIA. Ms. Zandt is an employee of IQVIA and a shareholder of IQVIA. Dr. Lau received research funding from Diabetes UK outside the scope of this work. Dr. Minty discloses a consulting relationship with Orpyx Medical Technologies, equity ownership in Orpyx Medical Technologies, and status as co-inventor on 2 patent applications (US 20250000440, US 20250000440), all of which are outside the scope of this work. Dr. You reports being a chief executive officer of PHI Digital Healthcare and grants from Daiichi Sankyo. He is a co-inventor of granted Korea Patent DP-2023-1223 and DP-2023-0920, and pending Patent Applications DP-2024-0909, DP-2024-0908, DP-2022-1658, DP-2022-1478, and DP-2022-1365, unrelated to current work. Dr. Man has received support from the C.W. Maplethorpe Fellowship, the National Institute of Health Research, European Commission Framework Horizon 2020, the Hong Kong Research Grant Council, and the Innovation and Technology Commission of the Hong Kong Special Administration Region Government, outside the submitted work). Dr. Hripcsak received a grant from Johnson & Johnson for methods work unrelated to this study. Dr. Krumholz has received expenses and/or personal fees from UnitedHealth, Element Science, Aetna, Reality Labs, Tesseract/4Catalyst, F-Prime, the Siegfried and Jensen Law Firm, the Arnold and Porter Law Firm, and the Martin/Baughman Law Firm; is a cofounder of Refactor Health, HugoHealth, and Ensight-AI; and is associated with contracts, through Yale New Haven Hospital, from the Centers for Medicare and Medicaid Services and, through Yale University, from Johnson & Johnson. Dr. Suchard receives additional contracts and grants from the US Food & Drug Administration, the US National Institutes of Health, Janssen Research & Development and Gliead Sciences outside the scope of this work. Dr. Lu received support from the National Heart, Lung, and Blood Institute of the National Institutes of Health (under awards R01HL69954 and R01HL169171), the Patient-Centered Outcomes Research Institute (under award HM-2022C2-28354), Sentara Research Foundation, and Novartis through Yale University. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.