Associations Between Sex, Race/Ethnicity, and HEART Score Guideline Implementation for Cardiac Testing in the Emergency Department.

Background: The HEART score is a widely used risk-stratification tool in suspected acute coronary syndrome (ACS), but it still suffers from several limitations. We aim to assess its diagnostic accuracy for predicting coronary computed tomography angiography (CCTA) findings and explore possible enhancement by integrating additional clinical variables. Methods: In this retrospective, observational study, consecutive patients presenting to the Emergency Department with suspected ACS and undergoing CCTA were analyzed. The study assessed the HEART score's diagnostic accuracy for predicting significant coronary artery stenosis (defined as ≥70% stenosis at CCTA) and explored improvements by integrating additional clinical variables for low-to-moderate-risk patients. Results: Three hundred seventy-nine patients were enrolled (age: 61 ± 15 years; male: 57%). According to the HEART score, 27% were at low risk, 67% moderate risk, and 6% high risk, with a prevalence of significant CAD of 7%, 27%, and 67%, respectively. The area under the curve (AUC) of the HEART score to predict significant CAD was 0.68. Male gender (OR = 1.76, 95% CI 1.03-3.02), right bundle branch block (OR = 4.15, 95% CI 1.66-10.40), and hemoglobin (OR = 1.21) and glucose levels (OR = 1.01) independently predicted significant coronary stenosis at CCTA in patients at low-to-moderate risk. Integrating these variables into the HEART score, the AUC improved from 0.68 to 0.74 (p = 0.004), with a net reclassification improvement of 13.5% (p = 0.032). Conclusions: Integrating additional clinical variables into the HEART score improves its accuracy to predict significant coronary artery stenosis at CCTA in suspected ACS patients at low-to-moderate risk. Tailoring assessments with these variables supports more accurate patient management and highlights the potential for more comprehensive diagnostic approaches.

Self-reported, computerized history taking (CHT) may enable efficient collection of medical histories for acute chest pain management. The primary aim is to determine the diagnostic performance of 4 CHT-derived chest pain risk scores for ruling out 30-day major adverse cardiac events (MACEs) or acute coronary syndrome (ACS). The secondary aim is to assess their impact on patient disposition in the emergency department (ED). This is a prospective cohort study conducted at a tertiary hospital ED in Stockholm, Sweden. Clinically stable adults (≥18 years) with chest pain and an electrocardiogram (ECG) not indicating an acute disease requiring immediate care provided medical histories via a tablet-based CHT program (Clinical Expert Operating System [CLEOS]). CHT data and ECG interpretations and troponin values were used to calculate the History, ECG, Age, Risk Factors, and Troponin (HEART) score, Danderyd HEART (D-HEART) score, Emergency Department Assessment of Chest Pain Score combined with an Accelerated Diagnostic Protocol (EDACS-ADP), and Troponin-only Manchester Acute Coronary Syndrome (T-MACS). The primary outcome was 30-day ACS; the secondary outcome was 30-day MACE (ACS, revascularization, or cardiovascular death). Among 1000 participants (age: mean 55 years, SD 17 years; 456/1000, 45.60%, women), risk scores could be calculated in 838 (83.80%). Within 30 days, 65 (6.50%) participants experienced ACS, and 72 (7.20%) had a MACE. Negative predictive values were 0.99 (95% CI 0.97-1.00) for both outcomes. Sensitivity for MACE was 0.91 (95% CI 0.81-0.97) for HEART, 0.94 (95% CI 0.86-0.98) for D-HEART, 0.94 (95% CI 0.86-0.98) for EDACS-ADP, and 0.97 (95% CI 0.90-1.00) for T-MACS, with similar results for ACS. As many as 89 of the 528 (16.9%) patients admitted could be reclassified from "nonlow risk" to "low risk." Among reclassified patients, 30-day MACE or ACS occurred in 0-4 cases; miss rates were below 1% for D-HEART (4/416, 0.96%) and T-MACS (2/286, 0.7%), but exceeded 1% for HEART (6/406, 1.5%) and EDACS-ADP (4/346, 1.2%). Automated, self-reported CHT provided sufficient data to calculate 4 chest pain risk scores in 838 of 1000 (83.80%) patients with acute chest pain, with score calculation dependent on physician-interpreted ECGs. These CHT-derived risk scores demonstrated good diagnostic performance for ruling out 30-day MACE and ACS. Performance was broadly comparable with prior studies using physician-acquired scores, although suggested safety thresholds were primarily met by D-HEART and T-MACS. The improved safety of D-HEART compared with HEART is likely attributable to the incorporation of serial 0/1-hour troponin testing. Use of CHT-derived risk scores may reclassify a substantial fraction of admitted patients as "low risk," potentially supporting discharge decisions in selected patients, while admission may still be required for non-ACS reasons. However, any gains in discharge rates should be weighed against the possibility of missed events among reclassified patients. Multicenter studies are needed to confirm generalizability, operational feasibility, and safety. ClinicalTrials.gov NCT03439449; https://clinicaltrials.gov/ct2/show/NCT03439449. RR2-10.1136/bmjopen-2019-031871.

Chest pain is a frequent reason for evaluation at military treatment facilities in the deployed setting. Deployed persons are generally at low risk of coronary disease as the underlying cause for these symptoms; however, morbidity and mortality from acute coronary syndrome in an austere environment can be catastrophic. For theaters with access to computed tomography (CT), Coronary CT Angiography (CCTA) offers a diagnostic modality to effectively rule out this high-risk diagnosis in low to intermediate risk patients. The researchers present a descriptive analysis of CCTA use at a deployed Role 3 over a deployment rotation spanning 8 months. The researchers devised a CCTA protocol and delivered this diagnostic modality at a deployed Role 3 MTF. They included patients presenting with chest pain and stratified by the treating cleinician as intermediate risk given a history, electrocardiogram, age, cardiac risk factors, Troponin T, HEART score, and bedside echo when available. The CT scanner used by the researchers was a Siemens SOMATOM go, Top 128 slice, 70 cm bore, equipped with hardware to perform electrocardiography (ECG) gated studies and postprocessing. The researchers beta blocked patients to a target heart rate of 50-60 prior to each study, and administered a single 0.4 mg tab of sublingual nitroglycerin 4-7 minutes prior to starting angiography. They performed pre-angiography unenhanced CCTA to determine calcium score. Later, they performed ECG gated CCTA following intravenous (IV) contrast administration. The researchers performed four CCTA studies on symptomatic patients, each of whom also received a pre-angiogram CT calcium score. All four patients successfully completed the protocol. All four patients had a calcium score of 0. CCTA was low risk without any visible coronary disease for two patients and non-diagnostic for the remaining two patients. There was no major adverse event. One patient experienced a small volume IV access site infiltration at the end of the contrast bolus injection which did not limit that respective exam. The remaining patients did not experience any minor or major adverse events. The initial data of this study is proof of concept that CCTA is feasible for assessing intermediate risk patients presenting with acute chest pain in the deployed setting, to rule our coronary pathology. The researchers' initial evaluation shows promise and suggests that this is a useful modality to continue to utilize and study in this environment.

Several studies investigated risk and prognostic parameters for horses with colic; however, the consensus is still debated. The present work aimed to investigate colic outcomes and to identify risk factors in horses referred for colic. In this multicenter retrospective study, 236 clinical records of equids referred for colic at three different equine centers were reviewed. The following data were collected: history, signalment, physical examination at the time of admission, hematological and biochemical analysis, diagnosis, SIRS status and 0-6 point-scale SIRS score, colic type, treatment attempted, and outcome. Descriptive statistics were performed, and distribution of continuous variables was reported as median and percentile. A multivariable logistic regression model was applied to assess parameters associated with colic outcomes in horses (p < 0.05). A total of 138/236 horses were included in the study. The univariate analysis identified as potentially associated with the outcome: sex (p = 0.046), colic type (p < 0.001), treatment type (p < 0.001), SIRS score (p = 0.049), age (p-value = 0.057), heart rate (p = 0.013), and respiratory rate (p = 0.017). The logistic regression model indicated that colic type (p < 0.001) and age (p = 0.004) were significantly associated with a negative outcome. Equine colic risks are multifactorial; prognosis declines with age and strangulating obstructive non-strangulating colic. Poor outcomes link to cardiovascular signs like elevated heart rate, SIRS status and score, and blood lactate. Heterogeneity from diverse sites limits generalizability, but standardized protocols, binarized data, and a multicenter approach enhance robustness and representativeness while reducing local biases.

Prognostic Value of HEART Score in Patients Presenting with Acute Chest Pain in Zagazig Emergency Department

Cardiac diseases refer to sudden, severe cardiac events with life-threatening consequences, often linked to underlying cardiovascular issues, requiring immediate medical intervention. Objectives: To determine the predictive accuracy of the HEART score versus electrocardiogram (ECG) changes for predicting Cardiac events in patients with chest pain. Methods: The study was carried out at the Punjab Institute of Cardiology (PIC), Lahore, and the Mekran Medical College, Turbat, from September 2020 to March 2021. The cross-sectional study included 385 patients. The samples of blood were collected and measured. Patients' HEART scores were calculated. The data were stratified by gender, age, duration of symptoms, smoking, and diabetes. The positive and negative predictive value, sensitivity, specificity, and diagnostic accuracy of the HEART score for each stratum were calculated. Results: There were 269 (69.9%) male and 116 (30.1%) female. The average age was 62.34 ± 8.48, and the age ranged from 35 to 75 years old. The mean duration of the symptom was 4.71 ± 2.24 hours. In predicting adverse events on the HEART score, results showed that 327 (84.9%) were positive, while 373 (96.9%) were positive for ECG changes. The sensitivity, specificity, positive and negative predictive value for predicting adverse events on the HEART score versus ECG changes were 86.7%, 66.7%, 98.7%, and 13.7% respectively. Conclusions: The HEART score effectively predicts major adverse events in chest pain patients, suggesting its continued validation as a clinical tool for risk stratification in emergency departments.

Chest pain (CP) is a common emergency department (ED) presenting symptom, requiring rapid assessment for acute coronary syndrome (ACS). The HEAR and HEART scores have been proposed to streamline patient evaluation. This study evaluated whether adding Focused Cardiac Ultrasound (FoCUS) could enhance risk stratification. Analysis of a prospective observational study involving adult patients at the ED of a University Hospital in Italy in 2022. Patients were stratified by the HEAR score into low (≤ 1) and mid-high risk (≥ 2) groups, and HEART score into low (≤ 3), mid (4-6), and high-risk (≥ 7) groups. All patients underwent FoCUS for regional wall motion abnormalities (RWMA). The primary outcome was non-ST-elevation (NSTE)-ACS within 30 days. We included 684 patients with median age of 58 years and 40% females. NSTE-ACS occurred in 106 (16%) patients, with 0/123 (0%) and 106/561 (19%) in low and mid-high-risk HEAR groups, respectively, and 6/337 (2%), 63/278 (23%) and 37/69 (54%) in low, mid and high-risk HEART groups, respectively. RWMA was found in 87 (13%) patients. In HEAR ≥ 2 (53% vs 13%, p < 0.001) and HEART 4-6 patients (50% vs 17%, p < 0.001), RWMA were associated with a higher frequency of NSTE-ACS. Multivariable analysis confirmed RWMA as an independent predictor of NSTE-ACS (OR 3.10, 95%CI 1.66-5.78). Including RWMA into the HEART score increased its sensitivity for high-risk patients (0.54 vs 0.35).Integrating RWMA identified by FoCUS into the HEAR and HEART scores might improve risk stratification for NSTE-ACS in patients presenting to the ED with chest pain.

This document describes the standardized corporate procedure developed by the USL Umbria 1 Health Authority to standardize the multidisciplinary approach to patients presenting with non-traumatic chest pain across its network of emergency departments, a common presentation requiring rapid differentiation between life-threatening conditions [e.g., acute coronary syndrome (ACS), aortic dissection, pulmonary embolism] and benign etiologies. The protocol mandates a structured pathway focusing on early risk stratification, including a 12-lead electrocardiogram (ECG) within 10 minutes of arrival and a comprehensive assessment to determine initial triage priority. For suspected ACS, the procedure involves serial cardiac biomarker (troponin) measurement (T0, T3h, and T6h) and HEART Score calculation to estimate the 30-day risk of major adverse cardiovascular events. High-risk patients (HEART Score 7 or clinically unstable) receive immediate cardiology consultation. Specifically for diagnosed ST-elevation myocardial infarction (STEMI) cases, the protocol integrates with the regional Umbria STEMI Network, ensuring immediate activation of the 118 emergency service for rapid secondary transport from spoke/antenna hospitals to a primary percutaneous coronary intervention (pPCI) hub center, with pPCI being the preferred reperfusion strategy and fibrinolysis reserved only if the time to pPCI exceeds 110-120 minutes from the first medical contact. Bedside echocardiography is an encouraged tool for rapid differential diagnosis and left ventricular function assessment. The implementation of this standardized, evidence-based protocol, integrated with the regional STEMI Network and leveraging rapid ECG teletransmission and risk scoring tools (Chest Pain Score, HEART), aims to ensure timely, guideline-driven, and appropriate care for all patients with non-traumatic chest pain across the USL Umbria 1 Emergency Departments.

[This retracts the article DOI: 10.7759/cureus.92630.].

A Prospective Observational Study to Find the 30 Days Prognostic Value of HEART Score in Emergency Medicine Department among South Indian Population

ABSTRACTObjectiveTo evaluate the diagnostic accuracy of a novel point of care (POC) high‐sensitivity troponin (hs‐cTn) assay, used alone or incorporated within validated decision aids, for acute myocardial infarction (AMI) in the prehospital setting.MethodsA pre‐specified secondary analysis of the Prehospital Evaluation of Sensitive Troponin (PRESTO) prospective diagnostic accuracy study, conducted in four ambulance services and 12 Emergency Departments (EDs; February 2019–March 2020). Paramedics included consenting adults with suspected AMI and no other reason for conveyance. Clinical data and venous blood were collected at the scene, and samples conveyed to hospital with participants. Plasma samples were later analyzed for hs‐cTn using a novel POC hs‐cTn assay (Abbott Point of Care i‐STAT hs‐TnI). The target condition was an adjudicated index diagnosis of type 1 AMI.ResultsOf 817 consenting participants, 704 were eligible for inclusion in this analysis, with type 1 AMI occurring in 89 (12.6%). At the limit of detection (< 2 ng/L), POC hs‐cTn had 100.0% sensitivity (95% CI 95 9%–100.0%) but only 4.6% specificity (95% CI 3.1%–6.5%). A Troponin‐only Manchester Acute Coronary Syndromes (T‐MACS) very‐low risk outcome identified 134 (19.7%) patients for non‐conveyance with 98.9% sensitivity (95% CI 94.9%–100.0%), 99.3% negative predictive value (NPV, 95% CI 95.0%–99.9%), and 22.5% specificity (95% CI 19.2%–26.1%). A low‐risk modified HEART score identified 150 (22.0%) patients with 93.2% sensitivity (95% CI 85.8%–97.5%), 96.0% NPV (91.6%–98.1%), and 24.3% specificity (95% CI 20.9%–27.9%). In an exploratory analysis, hs‐cTn < 5 ng/L identified 295 (41.9%) patients with 98.9% sensitivity (93.9%–100.0%), 99.7% NPV (97.7%–100.0%), and 47.8% specificity (95% CI 43.8%–51.8%).ConclusionsThis novel POC hs‐cTn assay achieves high sensitivity and NPV when used alongside the T‐MACS decision aid, but efficiency may be greater at a 5 ng/L threshold without requiring any decision aid.Trial RegistrationClinicalTrials.gov identifier: NCT03561051

Heart–Lung transplantation: Meeting allocation challenges in France

Background: Heartworm disease (HWD) represents the pathological consequences of heartworm (HW) (Dirofilaria immitis) infection on different organs and organ systems, primarily the lungs and heart. Radiography can objectively assess the severity of cardiopulmonary disease secondary to HW infection. However, interpreting dogs radiographs can be quite challenging in respect of choosing an appropriate radiographic method. Aim: The aim of this article is to review the published literature on radiographic methods, both subjective and objective, emphasizing their advantages and disadvantages. In order to define the feasibility and findings of the used radiographic methods, radiographs (laterolateral-LL and dorsoventral-DV) of dogs naturally infected with HWD (N=40) were analysed. Methods: Subjective radiographic assessment included all parameters of abnormal lung patterns and right-sided cardiomegaly in HWD. Objective methods used for the assessment of cardiac size and shape were: modified vertebral heart size (modified VHS), manubrium heart score (MHS), sternebral heart size (SHS), thoracic inlet heart size (TIHS), and cardiac sphericity index (CSI). Blood vessels were measured and expressed in relation to different skeletal structures or the aorta, depending on the blood vessels. Results: Whilst the increased sternal contact, reversed D heart shape, and loss of pulmonary vessel margination were the most feasible subjective parameters, the modified VHS, SHS and CSI (VHS-LL=10.52±0.97, VHS-DV=10.79±1.12; SHS-LL=9.22±1.04; SHS-DV=9.49±0.96; CSI-LL=0.86±0.08, CSI-DV=0.75±0.07) were the most feasible objective methods. The ratios of the right cranial lobar artery (RCrLA) to the fourth thoracic vertebra (T4) and the fourth rib (4.r) were the most feasible blood vessels measurements (RCrLA/T4=0.27±0.08, RCrLA/4.r=0.89±0.25). In 5% of the dogs radiographs could only be assessed subjectively. The most prevalent subjective parameters were increased sternal cardiac contact (91.89%), reversed D heart shape (89.65%), right caudal lobar artery enlargement (86.67%), and loss of pulmonary vessel margination (84.21%). The main pulmonary artery enlargement in LL, the loss of pulmonary vessel margination, and the areas of increased opacity that tend to coalesce, significantly changed after successful HWD therapy. Conclusion: The most feasible and prevalent subjective parameters were the increased sternal contact, reversed D heart shape, and loss of pulmonary vessel margination. The most feasible objective methods were the modified VHS, SHS and CSI.

Background: Heart failure (HF) is the leading cause of ED visits, thus patients must immediately assess their risk to make informed treatment choices. Emergency heart failure treatment is increasingly using clinical decision rules (CDRs) like the HEART score. More study is needed on their ED efficacy. Aim: This research examined how effectively CDRs predicted ED outcomes for HF patients. In the emergency room of King Hussein Medical Centre, this research examined how effectively and how frequently established CDRs treated acute HF. Planning for release and short-term problems was the emphasis. Methods: This research reviewed all adult HF patients (age 18 or older) presented to the ED between January 2024 and June 2025 using electronic health records. HF patients with acute decompensation were included. No patients with missing data, non-cardiac dyspnoea, or terminal conditions were included. We collected patient data, vital signs, lab findings, CDR usage (HEART-like route, MEESSI score components), and events (hospital admission, 30-day return, and death). ROC curves and multivariable logistic regression let us identify separate adverse event factors and assess the CDR's prediction ability. Results: The MEESSI-based rule accurately identified hospitalised patients (AUC=0.87, 95% CI: 0.85–0.89) and non-hospitalized patients (AUC=0.76, 95% CI: 0.73–0.79) in 1,420 patient interactions. The modified HEART-like circuit differentiated well at entrance (AUC=0.79) but not after 30 days (AUC=0.7). Multiple regression study indicated that high-acuity screening, qSOFA score, higher BNP, and ED crowds independently predicted admission. However, MEESSI high-risk categorisation, higher creatinine, and older age independently predicted the 30-day composite outcome. Conclusion: Well-known CDRs, notably those based on the MEESSI score, accurately predicted clinical outcomes in Jordanian tertiary care emergency departments for severe HF patients. These techniques may assist standardise risk ranking, make decisions, and optimise resources.

BackgroundElectrocardiograms (EKGs) are integral to the early evaluation of chest pain in the emergency department (ED), and the HEART score is frequently used for risk stratification of acute coronary syndrome (ACS). However, the HEART score typically relies on static EKG assessments, overlooking recent EKG changes that may reveal evolving ischemia. This study investigates the association between serial EKG changes and the need for urgent cardiac interventions, assessing whether integrating serial EKG data can enhance the predictive accuracy of the HEART score.MethodsWe conducted a single-center retrospective observational study of ED patients who presented at least twice with chest pain or equivalent symptoms from 2019 to 2023. Eligible patients had serial EKGs and documented HEART scores. New EKG changes were categorized into three groups: (1) new common ischemic patterns (e.g., T-wave inversions, ST-T segment depressions); (2) pseudo-normalization (e.g., resolution of prior abnormalities); and (3) new uncommon ischemic patterns (e.g., QT prolongation, U waves, LBBB, etc.). The primary outcome was the requirement for percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Propensity score matching was used to control confounding factors. Inter-rater agreement for EKG classification was assessed using Cohen’s kappa.ResultsAmong 1,862 patients, 149 (8.0%) underwent PCI/CABG interventions. New EKG changes were observed in nearly 80% of patients who required intervention, compared with less than 30% of those who did not (p < 0.001). The most frequent patterns were T-wave inversions and ST-T depressions. Despite higher HEART scores in the intervention group, 10.7% were misclassified as low risk under traditional scoring.ConclusionsNew EKG changes may be strongly associated with the need for PCI/CABG and provide prognostic value beyond static EKG interpretation. Relying solely on traditional HEART scoring may underestimate risk in a significant subset of patients.

Performance of EDACS, INTERCHEST, SCARE, and HEART Scores in Predicting Major Adverse Cardiac Events: A Prospective Multicenter Cohort Study

The HEART Pathway for Early Discharge in Acute Chest Pain identifies emergency department patients with acute chest pain as low risk for acute coronary syndrome and amenable to early discharge. The HEART Pathway was designed to more efficiently evaluate patients with acute chest pain using the previously validated HEART Score by making key modifications to the scoring rubric and adding a 3-hour troponin into an accelerated diagnostic pathway (ADP).

BackgroundBlood biomarkers represent the next generation of Alzheimer's disease (AD) diagnostics, enabling noninvasive, inexpensive, and scalable monitoring of amyloid‐beta (Aβ) plaque (A) and tau neurofibrillary tangles (T) pathologies and neurodegeneration (N). Plasma p‐tau217 has emerged as perhaps the most promising AD blood biomarker, prompting the development of several technologies to evaluate its prognostic and diagnostic utility. However, cross‐cohort validation studies in community‐based cohorts are lacking.MethodsHere, we assessed the Janssen plasma p‐tau217+ assay in three community‐based cohorts: the Monongahela Youghiogheny Healthy Aging Team‐Neuroimaging (MYHAT‐NI) with 113 participants (Aβ‐PET positivity=24.8%), the Human Connectome Project (HCP) comprising 234 participants (Aβ‐PET positivity= 15.0%) and the Heart Strategies Concentrating on Risk Evaluation study (Heart SCORE) made up of 154 participants (Aβ‐PET positivity=18.2%), all recruited from southwestern Pennsylvania, USA. We employed [11C] Pittsburgh Compound B (PiB) positron emission tomography (PET) imaging for brain Aβ load. We utilized receiver operating characteristic (ROC) curves to evaluate p‐tau217+ accuracies in detecting Aβ pathology, adjusting for age, sex, and APOE4 carrier status.ResultsThe Janssen p‐tau217+ assay exhibited high performance in identifying Aβ PET positivity in all three cohorts, with AUCs of 91% for MYHAT‐NI, 93% for HCP, and 82% for Heart SCORE. Plasma p‐tau217+ showed high specificity: MYHAT‐NI (57%), HCP (81%), Heart SCORE (87%) but poor sensitivity to Aβ PET: MYHAT‐NI (75%), HCP (70%), Heart SCORE (59%). p‐tau217+ was strongly correlated with Aβ‐PET SUVR and was stronger in the Aβ‐PET‐positive sub‐groups MYHAT‐NI (r = ‐0.1292; p = 0.2443), HCP (r = ‐0.1617; p = 0.0347), Heart SCORE (r = 0.1586; p = 0.0896). Importantly, correlation with Aβ‐PET was strongest in MYHAT‐NI which had the highest proportion of Aβ‐PET‐positive participants.ConclusionsThe Janssen p‐tau217+ assay identifies Aβ pathology in cognitively normal older adults in the community, underscoring its potential utility as a diagnostic tool for investigating AD at the population‐level.

Cognitive impairment (CI) in Alzheimer's disease (AD) is driven, among others in the AT(V)N framework, by tau and amyloid pathology, but individual responses to these pathologies vary widely. Some individuals maintain cognitive function despite significant pathology (resilience), while others remain pathology-free and cognitively intact (resistance). Emerging evidence suggests that health behavior factors, such as physical activity, cognitive engagement, and social interaction, along with demographic and clinical variables, may play a protective role. Our aim was to identify predictors of resistance and resilience. This study included 152 participants from the Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study with longitudinal imaging data and cognitive assessments. Tau burden was measured using [18F]Flortaucipir (FTP) and amyloid burden using [11C]Pittsburgh Compound-B (PiB) PET imaging. Cognition was categorized clinically as unimpaired or impaired (MCI or dementia) cognition. Resistance and resilience profiles were developed by combining tau, amyloid, and CI status (e.g., tau-resilient: tau-positive, CI-negative; tau-resistant: tau-negative, CI-negative). Stepwise logistic regression with a p-value cutoff of 0.2 was used to identify predictors of tau and amyloid resistance and resilience. Discrete-time survival analysis (logistic regression) was used to examine transitions to MCI/dementia. Model performance was assessed using the Area Under the ROC Curve (AUC) for discrimination and calibration plots for the accuracy of predicted probabilities. Calibration plots were generated using local regression (loess) and evaluated for internal validity. The demographic, clinical and health behavior characteristics of participants stratified by cognition status at baseline visit are summarized in Table 1. White race, history of CVD, cognitive activity were positively associated with tau resilience, while leisure activity was inversely related. Hypercholesterolemia showed an inverse association with tau resistance. Social activity, leisure activity, household activity, and education were positively associated with amyloid resistance. Within every year of study follow-up, amyloid positivity and tau-positivity predicted higher odds of progression to MCI/dementia, while CVD history, White race and cognitive activity predicted reduced lower odds. (See Table 2 & Figure 1 for model discrimination/calibration). Tau and amyloid status influence cognitive transitions, with health behavior factors, demographic and CVD history playing key roles in resistance and resilience.