{
  "abstract": "BackgroundCardiovascular-kidney-metabolic (CKM) syndrome affects nearly 90% of US adults, yet most individuals at early, modifiable stages remain unidentified outside clinical care. Blood donation centers offer a scalable, non-clinical venue for CKM screening, but the potential benefit of screening in this context remains unclear. We projected the population-level impact of effective digital return of results (ROR) to inform the design of a pragmatic trial.\n\nMethodsWe developed a Monte Carlo simulation (100,000 iterations) of the incident major adverse cardiovascular events (MACE), end-stage renal disease (ESRD), and type 2 diabetes (T2DM) preventable by ROR-prompted, guideline-concordant follow-up among donors in CKM Stages 1-2. The estimand counts only events averted by donors who act because of ROR; the intervention effect was modeled directly on strictly positive support, and action was translated into prevented events through a hazard-based cumulative-incidence difference that counts each donor at most once. We evaluated 18 design cells (donor volumes 300,000, 1 million, and 8 million/year; 5- and 10-year horizons; action-rate gains of +10, +20, and +30 percentage points [pp]) and, in a complementary two-arm simulation, the assurance (expected power) of detecting the effect in a single deployment.\n\nResultsUnder the primary +20 pp scenario, ROR at a single large blood center (300,000 donors/year) is projected to prevent a median of 2,201 events (95% uncertainty interval [UI], 1,099-4,364) over 10 years, scaling to 58,526 (29,154-116,769) at the national donor pool. All 18 design cells had strictly positive 95% lower bounds. The number needed to screen was 136 and the screening cost $2,045 per event prevented (at $15/donor), both invariant to donor volume. Impact scaled linearly with volume and effect size but sub-linearly with the horizon. Detection of the effect was effectively certain at gains of +20 pp or larger (assurance [≥]99.6% in every cell and >99.9% in all but the smallest 5-year cell).\n\nConclusionsEven under the conservative scenario, digital CKM ROR at blood donation centers is projected to prevent hundreds to tens of thousands of incident cardiometabolic events at a screening cost per event well within accepted prevention benchmarks, providing prospective, quantitative justification for a pragmatic, randomized evaluation of digital ROR in non-clinical screening settings.",
  "abstract_shown": true,
  "affiliations": [
    "UT Southwestern Medical Center"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "name": "Z. Qian"
    },
    {
      "name": "A. Khera"
    },
    {
      "name": "S. Makhnoon"
    },
    {
      "name": "B. E. Chapman"
    },
    {
      "name": "B. Bryant"
    },
    {
      "name": "M. Sayers"
    },
    {
      "name": "F. Compton"
    },
    {
      "name": "S. Eason"
    },
    {
      "name": "C. Xing"
    },
    {
      "affs": [
        0
      ],
      "name": "Z. Ahmad"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/3gg5f7hybshn0.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.09.01.26360806",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.09.01.26360806v1.full",
  "id": "3gg5f7hybshn0",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.09.01.26360806v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "public and global health"
    ],
    [
      "openalex",
      "1405|Blood donation and transfusion practices"
    ]
  ],
  "openalex": "W7208771896",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.09.01.26360806v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-01",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/3gg5f7hybshn0.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:39Z",
      "native_id": "10.64898/2026.09.01.26360806",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.09.01.26360806v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:public and global health",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "Projected Population-Level Impact of Digital Return of Results for Cardiovascular-Kidney-Metabolic Screening at US Blood Donation Centers: A Monte Carlo Simulation Study",
  "title_text": "Projected Population-Level Impact of Digital Return of Results for Cardiovascular-Kidney-Metabolic Screening at US Blood Donation Centers: A Monte Carlo Simulation Study",
  "type": "preprint",
  "updated_at": "2026-10-30T12:17:39Z",
  "url": "https://research.draconitic.com/paper/3gg5f7hybshn0",
  "venue": "medRxiv",
  "versions": []
}