Abstract:
BACKGROUND:Implantable cardioverter defibrillators (ICDs) effectively prevent sudden cardiac death, but selection of appropriate patients for implantation is complex. We evaluated whether risk stratification based on risk of sudden cardiac death alone was sufficient to predict the effectiveness and cost-effectiveness of the ICD. METHODS:We developed a Markov model to evaluate the cost-effectiveness of ICD implantation compared with empiric amiodarone treatment. The model incorporated mortality rates from sudden and nonsudden cardiac death, noncardiac death and costs for each treatment strategy. We based our model inputs on data from randomized clinical trials, registries, and meta-analyses. We assumed that the ICD reduced total mortality rates by 25%, relative to use of amiodarone. RESULTS:The relationship between cost-effectiveness of the ICD and the total annual cardiac mortality rate is U-shaped; cost-effectiveness becomes unfavorable at both low and high total cardiac mortality rates. If the annual total cardiac mortality rate is 12%, the cost-effectiveness of the ICD varies from $36,000 per quality-adjusted life-year (QALY) gained when the ratio of sudden cardiac death to nonsudden cardiac death is 4 to $116,000 per QALY gained when the ratio is 0.25. CONCLUSIONS:The cost-effectiveness of ICD use relative to amiodarone depends on total cardiac mortality rates as well as the ratio of sudden to nonsudden cardiac death. Studies of candidate diagnostic tests for risk stratification should distinguish patients who die suddenly from those who die nonsuddenly, not just patients who die suddenly from those who live.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Owens DK,Sanders GD,Heidenreich PA,McDonald KM,Hlatky MAdoi
10.1067/mhj.2002.125501subject
Has Abstractpub_date
2002-09-01 00:00:00pages
440-8issue
3eissn
0002-8703issn
1097-6744pii
S0002870302001072journal_volume
144pub_type
杂志文章abstract:OBJECTIVES:Impedance monitoring has been proposed as a method to assess the adequacy of tissue heating during catheter ablation procedures. The purpose of this study was to evaluate the relation among initial impedance, fall in impedance, and electrode temperature during catheter ablation procedures. METHODS AND RESUL...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(98)70130-9
更新日期:1998-11-01 00:00:00
abstract::We performed a chronologic investigation of left (LV) and right (RV) ventricular myosin ATPase activity and hemodynamics in newborn lambs. We found an elevation in myosin ATPase activity for the LV, which was achieved by 6 to 8 weeks of age and which correlated directly with increasing ventricular stroke work. Myosin ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(82)90396-9
更新日期:1982-05-01 00:00:00
abstract:BACKGROUND:The ODYSSEY COMBO I study (http://clinicaltrials.gov/show/NCT01644175) evaluated efficacy and safety of alirocumab as add-on therapy to stable maximally tolerated daily statin with or without other lipid-lowering therapy in high cardiovascular risk patients with suboptimally controlled hypercholesterolemia. ...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1016/j.ahj.2015.03.004
更新日期:2015-06-01 00:00:00
abstract::In this editorial, the problem of restenosis after coronary balloon angioplasty and other transluminal interventions is reviewed from the perspective of quantitative coronary angiography. The review is largely based on the experience of the Thoraxcentre in the application of quantitative angiography to the study of re...
journal_title:American heart journal
pub_type: 社论
doi:10.1016/0002-8703(93)90689-7
更新日期:1993-11-01 00:00:00
abstract::ECGs taken from four patients with concealed atrial bigeminy were analyzed to find the mechanisms of disappearance and reappearance of extrasystoles. Observations in three patients showing the classic form of concealed bigeminy suggest that when the extrasystole disappeared, the first sinus impulse after the last mani...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(84)90828-7
更新日期:1984-05-01 00:00:00
abstract::To study the left ventricular (LV) diastolic function in uncomplicated insulin-dependent diabetic patients without hypertension (n = 25) and comparable controls (n = 15), the effect of acute administration of nitroglycerin and nifedipine on cavity dimensions and transmitral flow pattern was investigated by Doppler ech...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(93)90542-h
更新日期:1993-12-01 00:00:00
abstract:BACKGROUND:The optimal hydration strategy for prevention of contrast-induced acute kidney injury (AKI) remains unknown. The purpose of this meta-analysis is to compare the effectiveness of normal saline (NS) versus sodium bicarbonate hydration (NaHCO(3)) for prevention of contrast-induced AKI. METHODS:We performed a m...
journal_title:American heart journal
pub_type: 杂志文章,meta分析
doi:10.1016/j.ahj.2008.05.014
更新日期:2008-09-01 00:00:00
abstract:BACKGROUND:In patients with acute myocardial infarction (AMI), the rate of microvascular embolization and no-reflow promoted by coronary stenting with the use of conventional techniques (CS) appears to be greater than the one that occurs with balloon angioplasty. The minor invasiveness of direct stenting (DS) of the in...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2001.117778
更新日期:2001-10-01 00:00:00
abstract:BACKGROUND:Quality improvement programs have shown increased use of beta-blockers post-myocardial infarction (MI), but there are no data on whether appropriate doses are administered. METHODS:In a prospective registry that enrolled consecutive patients with MI, we evaluated beta-blocker dosing at discharge after MI an...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2010.06.023
更新日期:2010-09-01 00:00:00
abstract:BACKGROUND:The long-term prognostic significance of elevated cardiac markers in an undifferentiated patient population with chest pain is unknown. METHODS:Serum troponin I (cTnI), creatine kinase-MB (CK-MB), and myoglobin were measured at presentation in 951 consecutive patients evaluated in the emergency department f...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2008.06.020
更新日期:2008-11-01 00:00:00
abstract:BACKGROUND:Despite a survival benefit and guideline recommendation for beta-blockers in left ventricular systolic dysfunction, beta-blockers are underused in clinical practice. METHODS:Medical practices with > or = 15 patients with heart failure (HF) in the Duke Databank for Cardiovascular Disease (DDCD) were identifi...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2005.06.038
更新日期:2006-05-01 00:00:00
abstract::To understand the process of atherosclerosis, the homeostatic and protective functions of the endothelium must be considered. The endothelium serves as the interface between blood flow and the vascular tissues. It normally regulates vascular tone and structure through the release of vasoactive substances and maintenan...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(94)90251-8
更新日期:1994-12-01 00:00:00
abstract:BACKGROUND:The treatment of cocaine-related acute coronary syndromes presents unique challenges. Although percutaneous coronary intervention in cocaine abusers appears to be safe in the short term, longer-term outcomes have not been reported. We postulated that cocaine use would be associated with increased risk for st...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2007.04.004
更新日期:2007-07-01 00:00:00
abstract::Intracoronary streptokinase (SK) is being used to treat acute myocardial infarction. Complications including atrioventricular (AV) block and both supraventricular and ventricular arrhythmias have been described. Selective cannulation of the nutrient arteries of the sinus node and AV node in the pentobarbital-anestheti...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(84)90825-1
更新日期:1984-05-01 00:00:00
abstract::The syndrome of fever and pericarditis is reported following implantation of a transvenous pacemaker in a 72-year-old man. The pacemaker was placed for prophylactic reasons (i.e., presence of bifascicular block). The syndrome resolved spontaneously after over four weeks of fever and a pericardial friction rub. Perfora...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(75)90227-6
更新日期:1975-11-01 00:00:00
abstract:BACKGROUND:Female sex independently predicts bleeding risk after percutaneous coronary intervention (PCI). Bivalirudin is safer than abciximab plus heparin in patients with non-ST-segment elevation myocardial infarction (NSTEMI). Thus, a greater benefit of bivalirudin in women would be expected. METHODS:We performed a...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2012.12.021
更新日期:2013-04-01 00:00:00
abstract::Hemodynamic and echocardiographic data from 33 consecutive patients undergoing cardiac transplantation were correlated with endomyocardial biopsy results to determine whether reversible restrictive hemodynamics accompany histologic evidence of transplant rejection. During the study period 251 biopsy specimens were obt...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(91)90475-w
更新日期:1991-10-01 00:00:00
abstract:OBJECTIVE:To date, few studies have evaluated asymptomatic patients with organic mitral regurgitation (MR). The goal of the present study was to assess the presence of independent predictive factors for progression of symptoms and/or left ventricular dysfunction (SLVSD) in this population. METHODS:We prospectively eva...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2006.01.015
更新日期:2006-11-01 00:00:00
abstract:BACKGROUND:Angiotensin-converting enzyme (ACE) inhibitors are established as first-line therapy in chronic heart failure (CHF). However, conflicting results exist regarding the dose-effect relation of ACE inhibitors. METHODS:We investigated 45 patients (age 55 +/- 10 years) with stable CHF who presented with a mainten...
journal_title:American heart journal
pub_type: 临床试验,杂志文章
doi:10.1016/s0002-8703(99)70179-1
更新日期:1999-10-01 00:00:00
abstract::Bacterial shock due to Gram-negative bacilli is best managed by prompt control of the infection with appropriate antibiotics and surgical drainage or excision. Corticosteroids for purposes of controlling systemic reactions to bacteria and their toxins constitute adjunctive therapy. Volume repletion and respiratory sup...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(77)80352-9
更新日期:1977-07-01 00:00:00
abstract:BACKGROUND:Pregnancy is increasingly common in women with congenital heart disease (CHD), but little is known about long-term cardiovascular outcome after pregnancy in these patients. We studied the incidence of cardiovascular events 1-year postpartum and compared cardiac function prepregnancy and 1-year postpartum in ...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2014.11.010
更新日期:2015-02-01 00:00:00
abstract:BACKGROUND:Postinterventional cognitive dysfunction (PICD) is a known complication of coronary artery bypass grafting (CABG). However, it is largely unknown whether PICD occurs after coronary catheterization. METHODS:Neuropsychologic data were obtained from 37 patients who received coronary catheterization and 47 pati...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2011.07.021
更新日期:2011-10-01 00:00:00
abstract:BACKGROUND:The ACUTE Trial studied a transesophageal echocardiography (TEE)-guided strategy compared with a conventional strategy for management of patients with atrial fibrillation undergoing direct current cardioversion. The primary aim was to determine if patient functional capacity, measured by the Duke Activity St...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2004.08.014
更新日期:2005-02-01 00:00:00
abstract:BACKGROUND:Evidence from numerous studies of coronary angiography show differences between observers' assessments of 15% to 45%. The implication of this variation is serious: If readings are erroneous, some patients will undergo revascularization procedures unnecessarily and others will be denied an essential treatment...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/s0002-8703(00)90316-8
更新日期:2000-01-01 00:00:00
abstract:BACKGROUND:Atrial fibrillation (AF) continues to be one of the most common cardiac problems, placing an expanding burden on the public health system. In several circumstances, AF can increase the risk of stroke and heart failure. Current pharmacologic treatment options are associated with the potential for significant ...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2009.05.024
更新日期:2009-08-01 00:00:00
abstract::A pilot study was performed to determine the safety and efficacy of coronary pulsed mid-infra-red laser angioplasty. The laser was coupled with a novel 2.0 mm multifiber catheter consisting of 37 optical fibers of 150 microns each arranged concentrically around a 0.018-inch central lumen and a soft leading tapered dis...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(91)91015-f
更新日期:1991-08-01 00:00:00
abstract::Fifteen cases of the sick-sinus syndrome in young Negroes are presented. The etiology was unknown in all cases; organic heart disease was absent. The very high default rate suggests that the prognosis may be grave. This disorder is by no means uncommon in young persons in tropical countries and the dangers of a mistak...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(75)90078-2
更新日期:1975-03-01 00:00:00
abstract::Of 178 transseptal left heart catheterizations performed, 173 successful cases are reported, with the use of a Swan-Ganz, flow-directed, balloon-tipped catheter. By means of a modified Brockenbrough technique, which is described in detail, a 10F Teflon tube (3.3 mm outside diameter) was inserted into the left atrium. ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(85)90603-9
更新日期:1985-02-01 00:00:00
abstract::We attempted to predict successful myocardial reperfusion and salvage in acute myocardial infarction (AMI) by using measurements of plasma superoxide dismutase (SOD), a plasma free-radical scavenger, activity. Forty-nine patients with AMI were studied within 6 hours of symptoms onset. In group 1 (n = 26), primary perc...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(96)90163-5
更新日期:1996-05-01 00:00:00
abstract::Although it has been shown that early cardiac rejection can be visualized by radioimmunoscintigraphy targeting major histocompatibility complex class II antigen, the use of antibodies that bind to a polymorphic determinant of class II antigen has certain disadvantages for clinical application. This investigation was d...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(94)90050-7
更新日期:1994-05-01 00:00:00