Abstract：
BACKGROUND:Physician adherence to guidelines is often poor, but the reasons have not been completely studied. We investigated whether physician adherence to guidelines for percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) varied by source, development methods, or the extent of their evidence-base. METHODS AND RESULTS:We assessed adherence to guidelines developed by the American College of Cardiology/American Heart Association (ACC/AHA) for PTCA (1988 and 1993) and for CABG (1990) and guidelines developed by RAND for PTCA and CABG in 1990. We randomly sampled patients on Medicare who were undergoing coronary angiography in 5 states in 1991 and 1992, extracting clinical and laboratory data from medical records and using computer programs to classify the appropriateness of each procedure. A total of 543 PTCA and 676 CABG procedures were studied. By use of the 1988 ACC/AHA guidelines, 30% of PTCAs were rated class III (inappropriate), whereas 24% were class III by use of the 1993 guidelines. Only 1.5% of CABG procedures were class III with ACC/AHA guidelines. By use of RAND guidelines, 12% of PTCA and 9% of CABG procedures were classified as inappropriate. CONCLUSIONS:Adherence to guidelines is higher when the recommendations are supported by evidence from randomized clinical trials (CABG). The credibility of the source and familiarity with the guidelines do not ensure compliance. When evidence is lacking, as with PTCA at the time of this study, guideline recommendations may lag behind appropriate changes in clinical practice. More frequent revisions coupled with on-line access have the potential to make guidelines more useful.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Leape LL,Weissman JS,Schneider EC,Piana RN,Gatsonis C,Epstein AMdoi
10.1067/mhj.2003.35subject
Has Abstractpub_date
2003-01-01 00:00:00pages
19-26issue
1eissn
0002-8703issn
1097-6744pii
S0002870302947447journal_volume
145pub_type
杂志文章abstract：:The purpose of this study was to assess the recovery of the left ventricular pressure (PLV), and the incidence and type of arrhythmias after effective low-dose defibrillation (Imax = 18-70 A) in healthy hearts and in hearts with acute myocardial infarction (AMI) in the intact dog. In fifteen dogs 84 episodes of fibril...
journal_title：American heart journal
pub_type： 杂志文章
doi：10.1016/0002-8703(83)90195-3
更新日期：1983-08-01 00:00:00
abstract：:Percutaneous transluminal coronary angioplasty (PTCA) was performed in 110 consecutive patients (111 vessels) with chronically occluded coronary arteries and was successful in 69 patients (69 vessels). Successful initial PTCA was related to the extent of coronary artery disease, the morphology of the proximal surface ...
journal_title：American heart journal
pub_type： 杂志文章
doi：10.1016/0002-8703(94)90503-7
更新日期：1994-01-01 00:00:00
abstract：:Transthoracic echocardiography has played a useful role in the screening of cardiac transplant donors. However, transthoracic echocardiograms may be suboptimal in many patients on ventilators. The role of transesophageal echocardiography in cardiac donor screening is unknown. Therefore we compared the potential benefi...
journal_title：American heart journal
pub_type： 杂志文章
doi：10.1016/0002-8703(93)90758-2
更新日期：1993-06-01 00:00:00
abstract：OBJECTIVES:The study aimed to analyze the use of intensive lipid-lowering therapy (I-LLT) at discharge in a broad population of patients hospitalized with acute coronary syndrome (ACS). BACKGROUND:Early and intensive statin therapy in ACS has been shown to reduce cardiovascular morbidity and mortality. Utilization and...
journal_title：American heart journal
pub_type： 杂志文章,多中心研究
doi：10.1016/j.ahj.2010.12.014
更新日期：2011-02-01 00:00:00
abstract：:Electrophysiologic studies were prospectively performed in 91 consecutive patients referred for evaluation of sustained ventricular tachycardia or sudden cardiac death. Fifty-two patients had a history of sustained ventricular tachycardia and 39 patients had a history of sudden cardiac death. The identical stimulation...
journal_title：American heart journal
pub_type： 杂志文章
doi：10.1016/0002-8703(85)90088-2
更新日期：1985-09-01 00:00:00
abstract：AIMS:In adults with coarctation of the aorta (CoA), hypertension (HTN) is a common long-term complication. We investigated the prevalence of HTN and analyzed factors associated with HTN. METHODS AND RESULTS:In the national register for congenital heart disease, 653 adults with repaired CoA were identified (mean age 36...
journal_title：American heart journal
pub_type： 杂志文章
doi：10.1016/j.ahj.2016.07.012
更新日期：2016-11-01 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:Previous works have suggested an association between Chlamydia pneumoniae infection and coronary heart disease. We evaluated the prevalence of C. pneumoniae infection in patients with acute myocardial infarction (AMI) and coronary heart disease (CHD). METHODS AND RESULTS:Ninety-eight patients with AMI, 80 p...
journal_title：American heart journal
pub_type： 杂志文章
doi：10.1016/s0002-8703(99)70371-6
更新日期：1999-06-01 00:00:00
abstract：:Recognition of tachyarrhythmia by an implantable cardioverter-defibrillator (ICD) requires an intact rate-sensing lead. We retrospectively examined 266 consecutive patients requiring an ICD to characterize the incidence, clinical presentation, diagnosis, and management of a defective rate-sensing lead. To identify cli...
journal_title：American heart journal
pub_type： 杂志文章
doi：10.1016/0002-8703(94)90585-1
更新日期：1994-11-01 00:00:00
abstract：:Dobutamine (and dopamine) are potent positive inotropic drugs which are frequently given to treat decompensated congestive heart failure. This study reports on the use of ambulatory dobutamine (and dopamine) infusions in 21 outpatients with advanced congestive heart failure. Each patient was initially hospitalized, an...
journal_title：American heart journal
pub_type： 杂志文章
doi：10.1016/0002-8703(87)90757-5
更新日期：1987-09-01 00:00:00
abstract：:Our understanding of the pathogenesis of congestive heart failure (CHF) has improved remarkably in recent years. However, despite better knowledge and novel pharmaceutical strategies, this disease is still one of the most brutal killers in the Western world. The pathophysiology of CHF is complex, and much of our compr...
journal_title：American heart journal
pub_type： 杂志文章,评审
doi：10.1067/mhj.2003.163
更新日期：2003-03-01 00:00:00
abstract：:We devised a nine-lead Holter monitor system with a lead-switching technique to record electrocardiograms from multiple sites in the anterior and the posterior or lateral chest. Leads CM1 to CM6, high lateral (HL), low lateral (LL), and low posterior chest (LB) were used. The sensitivity, specificity, and predictive a...
journal_title：American heart journal
pub_type： 临床试验,杂志文章
doi：10.1016/0002-8703(94)90595-9
更新日期：1994-11-01 00:00:00
abstract：:Reperfusion therapy has lowered the mortality in patients suffering acute myocardial infarction. Failure to reperfuse is associated with significantly higher risk of short- and long-term mortality. Detection of reperfusion is thus important. In a prospective pilot study, we used continuous on-line computerized vectorc...
journal_title：American heart journal
pub_type： 杂志文章
doi：10.1016/0002-8703(91)90455-q
更新日期：1991-10-01 00:00:00
abstract：:Early postexercise polarcardiographic (PCG) changes in the ST segment vector, as reflected in the variable MS X theta, are reported to clearly distinguish normal subjects from those with myocardial ischemia. We prospectively assessed the value of this test in detecting coronary artery disease (CAD) during treadmill ex...
journal_title：American heart journal
pub_type： 杂志文章
doi：10.1016/0002-8703(85)90019-5
更新日期：1985-12-01 00:00:00
abstract：:Ambulatory ECG recordings were obtained from 313 consecutive, totally symptom-free male subjects on whom cardiac catheterization was subsequently performed for occupational reasons. These recordings were examined for ventricular ectopy and the results were studied in relation to the findings on selective coronary angi...
journal_title：American heart journal
pub_type： 杂志文章
doi：10.1016/0002-8703(89)90405-5
更新日期：1989-06-01 00:00:00
abstract：:Of 26,294 consecutive patients monitored in a comprehensive drug surveillance program, 1067 (4 per cent) received methyldopa for treatment of hypertension. Adverse reactions attributed to methyldopa were reported in 149 patients (14 per cent), the most frequent being hypotension. Life-threatening adverse effects were ...
journal_title：American heart journal
pub_type： 杂志文章
doi：10.1016/0002-8703(78)90192-8
更新日期：1978-11-01 00:00:00
abstract：:The efficacy and safety of sotalol therapy for ventricular arrhythmias was evaluated in 133 patients with drug-refractory ventricular arrhythmias. All patients had baseline electrophysiologic studies before and after oral sotalol therapy. Sixty-six patients were discharged home, treated with sotalol (52 patients witho...
journal_title：American heart journal
pub_type： 杂志文章
doi：10.1016/s0002-8703(96)90008-3
更新日期：1996-11-01 00:00:00
abstract：BACKGROUND:Health care utilization patterns and associated costs of congenital heart disease (CHD) in young adulthood are not well understood. METHODS:California State Inpatient Databases 2005 to 2009 were used to conduct a retrospective study on inpatient admissions of CHD patients 10 to 29 years old (n = 7,419) and ...
journal_title：American heart journal
pub_type： 杂志文章
doi：10.1016/j.ahj.2014.08.006
更新日期：2014-12-01 00:00:00
abstract：:A significant diuretic and natriuretic response occurs during paroxysmal supraventricular tachycardia (SVT). Although the diuresis may be secondary to suppression of vasopressin secretion, the etiology of the natriuresis remains unexplained. To determine if atrial natriuretic factor (ANF) could contribute to the polyu...
journal_title：American heart journal
pub_type： 杂志文章
doi：10.1016/0002-8703(86)90301-7
更新日期：1986-11-01 00:00:00
abstract：:We studied the prevalence and clinical significance of transient U wave inversion in 43 patients with variant angina. Twenty-four patients (group A) had ST segment elevation in the anterolateral and 19 patients (group B) had this finding in the inferoposterior leads of the ECG during spontaneous angina. In none of the...
journal_title：American heart journal
pub_type： 杂志文章
doi：10.1016/0002-8703(84)90452-6
更新日期：1984-10-01 00:00:00
abstract：BACKGROUND:Elevated resting heart rate (RHR) is known to be associated with reduced survival but inconsistencies remain, including lack of significance in most studies of healthy women, lack of independence from systolic blood pressure (SBP) in some, and the suggestion that RHR is merely functioning as a marker of phys...
journal_title：American heart journal
pub_type： 杂志文章
doi：10.1016/j.ahj.2009.12.029
更新日期：2010-04-01 00:00:00
abstract：:We investigated the relationship between plasma atrial natriuretic polypeptide (ANP) levels and hemodynamic indices during dynamic exercise testing in 15 patients with effort angina pectoris. Patients exercised on an angina-limited, supine, multistage bicycle ergometer, and plasma ANP levels and hemodynamic indices we...
journal_title：American heart journal
pub_type： 杂志文章
doi：10.1016/0002-8703(90)90239-t
更新日期：1990-12-01 00:00:00
abstract：:A large series of 306 patients with ischemic heart disease was studied with automated systolic time intervals and left ventricular ejection fraction as determined by the angiocardiographic method. It was found the pre-ejection period, left ventricular ejection time, delta values, and PEP/LVET ratio all were related to...
journal_title：American heart journal
pub_type： 杂志文章
doi：10.1016/s0002-8703(77)80407-9
更新日期：1977-04-01 00:00:00
abstract：BACKGROUND:The inverse relation between alcohol intake and clinical coronary artery disease (CAD) is well established, although the mechanisms remain speculative. We studied the relation between alcohol intake and subclinical CAD to assess the possible role of alcohol in atherogenesis. METHODS:We conducted a prospecti...
journal_title：American heart journal
pub_type： 杂志文章
doi：10.1016/j.ahj.2004.05.023
更新日期：2004-11-01 00:00:00
abstract：BACKGROUND:Atrial fibrillation (AF) ablation is superior to pharmacologic therapy in achieving maintenance of normal sinus rhythm in selected patient populations. However, the procedure is resource intensive, and repeat ablations are sometimes required. We examined the predictors and trends of repeat ablation using a l...
journal_title：American heart journal
pub_type： 杂志文章,多中心研究
doi：10.1016/j.ahj.2015.10.015
更新日期：2016-01-01 00:00:00
abstract：BACKGROUND:To evaluate the impact of adjunctive high-dose glucose-insulin-potassium (GIK) on ST-segment elevation resolution in patients with ST-segment elevation myocardial infarction (MI). METHODS:As part of a randomized controlled trial of GIK versus no GIK in patients treated with primary percutaneous coronary int...
journal_title：American heart journal
pub_type： 杂志文章,随机对照试验
doi：10.1016/j.ahj.2005.03.023
更新日期：2005-06-01 00:00:00
abstract：BACKGROUND:Little is known about the role of diet in the development of venous thromboembolism (VTE). We explored the prospective relation of dietary patterns, food groups, and nutrients to incident VTE in older women. METHODS:In 1986, Iowa women aged 55 to 69 years completed a mailed survey, including a 127-item food...
journal_title：American heart journal
pub_type： 杂志文章
doi：10.1016/j.ahj.2009.04.003
更新日期：2009-06-01 00:00:00
abstract：BACKGROUND:The major structural characteristic of congestive heart failure is myocardial cell death. The aim of our study was to determine whether the level of cardiac troponin T, a protein specific for cardiac necrosis, was increased in patients with congestive heart failure. METHODS AND RESULTS:Plasma samples were o...
journal_title：American heart journal
pub_type： 杂志文章
doi：10.1016/s0002-8703(99)70252-8
更新日期：1999-07-01 00:00:00
abstract：:A prospective study examining the relationship between psychological distress and ventricular ectopy was conducted with 125 post-myocardial infarction patients equipped with a transtelephonic ECG monitor. Subjects were subsequently grouped according to the occurrence (n = 59) or nonoccurrence (n = 65) of ventricular a...
journal_title：American heart journal
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1016/0002-8703(88)90246-3
更新日期：1988-07-01 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
