Abstract:
AIMS:The extent to which hospital and geographic characteristics influence the time course of uptake of evidence from key clinical trials and practice guidelines is unknown. The gap between evidence and practice is well recognized but the factors influencing this disjunction, and the extent to which such factors are modifiable, remain uncertain. METHODS AND RESULTS:Using chronological data from the GRACE registry (n=12666, July 1999 to December 2001), we test the hypothesis that hospital and geographic characteristics influence the time course of uptake of evidence-based guideline recommendations for acute coronary syndromes (ACS) with and without ST elevation. Certain therapies were widely adopted in both ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) patients (aspirin >94% of all patients; beta-blockers 85-95%) and changed only modestly over time. Significant increases in the use of low-molecular-weight heparins and glycoprotein IIb/IIIa inhibitors occurred in STEMI and NSTEMI patients in advance of published practice guidelines (September/November 2000) with marked geographical differences. The highest use of LMWH was in Europe in NSTEMI (86.8%) and the lowest in the USA (24.0%). Contrasting geographical variations were seen in the use of percutaneous coronary intervention (PCI) in NSTEMI: 39.5% USA, 34.6% Europe, 33.5% Argentina/Brazil, 25.0% Australia/New Zealand/Canada (July-December 2001). Theuse of PCI was more than five times greater in hospitals with an on-site catheterization laboratory compared to centres without these facilities, and geographic differences remained after correction for available facilities. CONCLUSIONS:Hospital and geographical factors appear to have a marked influence on the uptake of evidence-based therapies in ACS management. The presentation and publication of major international guidelines was not associated with a measurable change in the temporal pattern of practice. In contrast, antithrombotic and interventional therapies changed markedly over time and were profoundly influenced by hospital and geographic characteristics.
journal_name
Eur Heart Jjournal_title
European heart journalauthors
Fox KA,Goodman SG,Anderson FA Jr,Granger CB,Moscucci M,Flather MD,Spencer F,Budaj A,Dabbous OH,Gore JM,GRACE Investigators.doi
10.1016/s0195-668x(03)00315-4subject
Has Abstractpub_date
2003-08-01 00:00:00pages
1414-24issue
15eissn
0195-668Xissn
1522-9645pii
S0195668X03003154journal_volume
24pub_type
杂志文章,多中心研究abstract:AIMS:Thrombin is an important factor in the pathogenesis of thrombotic diseases. To clarify whether smoking has an effect in platelet-dependent thrombogenesis, we studied the acute effects of smoking on platelet-dependent thrombin level in smokers. METHODS AND RESULTS:Subjects consisted of ten smokers and nine non-smo...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1053/euhj.1999.1938
更新日期:2001-01-01 00:00:00
abstract::Torsade de pointes may occur as a complication of amiodarone therapy. We report a patient receiving amiodarone who was resuscitated from cardiovascular collapse and documented ventricular fibrillation. At subsequent electrophysiology study, while the patient was taking amiodarone therapy, monophasic action potentials ...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a059849
更新日期:1991-10-01 00:00:00
abstract::AIMS More intense platelet-directed therapy for acute coronary syndrome (ACS) may increase bleeding risk. The aim of the current analysis was to determine the rate, clinical impact, and predictors of major and fatal bleeding complications in the PLATO study. METHODS AND RESULTS PLATO was a randomized, double-blind, ac...
journal_title:European heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1093/eurheartj/ehr422
更新日期:2011-12-01 00:00:00
abstract:AIMS:To identify changes in multidirectional strain and strain rate (SR) in patients with aortic stenosis (AS). METHODS AND RESULTS:A total of 420 patients (age 66.1 ± 14.5 years, 60.7% men) with aortic sclerosis, mild, moderate, and severe AS with preserved left ventricular (LV) ejection fraction [(EF), ≥50%] were in...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehr084
更新日期:2011-06-01 00:00:00
abstract::Two-dimensional echocardiography (2D echo) and Doppler were performed in a group of patients who had a high probability of having right ventricular (RV) dysplasia (left bundle branch block arrhythmias, no signs of cardiopulmonary diseases) and in a group of age-matched normals. 2D echo showed RV morphofunctional abnor...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/10.suppl_d.29
更新日期:1989-09-01 00:00:00
abstract:AIMS:To investigate the long-term benefits of treatment with angiotensin-converting enzyme (ACE)-inhibitors in patients with myocardial infarction (MI) and left ventricular dysfunction (LVD). METHODS AND RESULTS:In the trandolapril cardiac evaluation (TRACE) study, 1749 patients with LVD (ejection fraction< or =35%) w...
journal_title:European heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/eurheartj/ehi021
更新日期:2005-01-01 00:00:00
abstract::An 83-year-old man was hospitalized due to general fatigue and dyspnoea. He was diagnosed as having complete atrioventricular (AV) block due to cardiac involvement by a malignant lymphoma. Eleven days after the initiation of chemotherapy, the complete AV block disappeared and only a first degree AV block remained. ...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a060514
更新日期:1994-03-01 00:00:00
abstract::The efficacy of sustained-release diltiazem (diltiazem-SR) 120 mg b.i.d. was compared with metoprolol 100 mg b.i.d. in 12 patients with stable angina. Following a 1-week placebo period, patients received diltiazem-SR or metoprolol in two 3-week treatment periods, in a randomized double-blind crossover design. Total ex...
journal_title:European heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1093/oxfordjournals.eurheartj.a059403
更新日期:1989-10-01 00:00:00
abstract:AIMS:To investigate the efficacy and outcome of emergency percutaneous coronary interventions (PCI) in patients with stent thrombosis. METHODS AND RESULTS:Between 1995 and 2003, 6058 patients underwent bare-metal stent implantation, of which 95 (1.6%) patients suffered from stent thrombosis. The timing of stent thromb...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehi135
更新日期:2005-06-01 00:00:00
abstract::The purpose of this study was to describe the mechanism and determine predictive factors of mitral valve rupture requiring valve replacement following percutaneous mitral commissurotomy. Of the 350 consecutive patients treated by balloon mitral commissurotomy, the procedure was not completed in 16, and 11 developed ac...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/16.1.43
更新日期:1995-01-01 00:00:00
abstract:AIM:Elevated brain natriuretic peptide (BNP) and tumour marker antigen carbohydrate 125 (CA125) levels have shown to be associated with higher risk for adverse outcomes in patients with acute heart failure (AHF). Nevertheless, no attempt has been made to explore the utility of combining these two biomarkers. We sought ...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehq142
更新日期:2010-07-01 00:00:00
abstract:AIMS:Reperfusion injury following acute myocardial infarction impacts not only on the myocardium but also on the coronary microcirculation, and microembolization from the culprit lesion contributes to microvascular obstruction. Prior experimental studies have not accounted for microembolization in ischaemia/reperfusion...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehs434
更新日期:2013-11-01 00:00:00
abstract::A major consequence of chronic cardiac dysfunction is chronic overload of contractile myocardium. Various aetiologies, in reaction to this, may induce compensatory mechanisms consisting of excentric (dilatation) and concentric hypertrophy. Chronic left ventricular dysfunction is caused most frequently by myocardial in...
journal_title:European heart journal
pub_type: 杂志文章,评审
doi:10.1093/eurheartj/14.suppl_a.33
更新日期:1993-07-01 00:00:00
abstract::The prevalence and type of arrhythmias has been studied in a representative sample of 2000 Athenians, aged 18-81 years, who underwent exercise testing on a treadmill according to the Bruce protocol. It was found that 121 persons (mean age 55.7 +/- 14.9 years, 31% greater than 65 years), exhibited arrhythmias on the EC...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/8.suppl_d.17
更新日期:1987-08-01 00:00:00
abstract:AIMS:Targeting interleukin-1 (IL-1) represents a novel therapeutic approach to atherosclerosis. CANTOS demonstrated the benefits of IL-1β neutralization in patients post-myocardial infarction with residual inflammatory risk. Yet, some mouse data have shown a prominent role of IL-1α rather than IL-1β in atherosclerosis,...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehz008
更新日期:2019-08-07 00:00:00
abstract::This report describes the results of right ventricle endomyocardial biopsies from 26 subjects (mean age 27 +/- 10 years) with premature ventricular beats and normal cardiac anatomy and mechanical function. Light microscopy examination revealed normal myocardium in 10 subjects (38%), acute myocarditis in two (7%), bord...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a060248
更新日期:1992-06-01 00:00:00
abstract:AIMS:In the dual antiplatelet therapy (DAPT) study, continued thienopyridine beyond 12 months after drug-eluting stent placement was associated with increased mortality compared with placebo. We sought to evaluate factors related to mortality in randomized patients receiving either drug-eluting or bare metal stents in ...
journal_title:European heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1093/eurheartj/ehv614
更新日期:2016-01-21 00:00:00
abstract::To determine the effects of acute myocardial infarction on the extent and distribution of mural stress on surviving myocardial tissue, coronary artery occlusion was surgically produced in rats. Following haemodynamic measurements in vivo, the characteristics of cardiac anatomy were determined and found to consist of a...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/16.suppl_n.37
更新日期:1995-12-01 00:00:00
abstract::To compare the blood pressure (BP) changes during a long-distance run with those during bicycle ergometry, nine normotensive and 18 hypertensive joggers were studied by means of ambulatory intra-arterial monitoring. In all subjects the ergometric test caused a progressive increase in systolic and little change in dias...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a059709
更新日期:1990-04-01 00:00:00
abstract:Aims:To characterize the relationship between blood pressure (BP) or heart rate and mortality and morbidity in chronic obstructive pulmonary disease (COPD). Methods and results:We performed post hoc analysis of baseline BP or heart rate and all-cause mortality and cardiovascular events in the SUMMIT trial. SUMMIT was ...
journal_title:European heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1093/eurheartj/ehy451
更新日期:2018-09-01 00:00:00
abstract::During urgent cardiac catheterization total occlusion of a severe left main coronary artery stenosis occurred, leading to profound cardiogenic shock. The patient survived, after prompt left main coronary angioplasty was performed, followed by emergency coronary bypass surgery. ...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a059437
更新日期:1989-12-01 00:00:00
abstract:AIMS:Induced pluripotent stem cells (iPSCs) provide a unique opportunity for the generation of patient-specific cells for use in disease modelling, drug screening, and regenerative medicine. The aim of this study was to compare human-induced pluripotent stem cells (hiPSCs) derived from different somatic cell sources re...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehs203
更新日期:2013-09-01 00:00:00
abstract::Valvular heart disease is a significant, global cause of morbidity and mortality. In the ageing population of industrialized nations, degenerative aortic stenosis has become the most common native valve disorder. Although surgical aortic valve replacement is associated with excellent clinical outcomes, a large number ...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehp260
更新日期:2009-09-01 00:00:00
abstract:AIMS:Cardiovascular risk factors such as elevated serum lipid levels are important in the development of coronary atherosclerosis. Radiofrequency (RF) analysis of intravascular ultrasound [IVUS, Virtual histology (VH)] offers a unique tool to study the composition of coronary atherosclerotic plaque in vivo. We used dat...
journal_title:European heart journal
pub_type: 杂志文章,多中心研究
doi:10.1093/eurheartj/ehp428
更新日期:2010-01-01 00:00:00
abstract::ACE inhibitors may influence the actual concentrations of the peptides angiotensin I, angiotensin II and bradykinin. Since all three peptides are able to modulate catecholamine release, a change in noradrenaline and adrenaline release should be expected when angiotensin I converting enzyme (kininase II) is inhibited. ...
journal_title:European heart journal
pub_type: 杂志文章,评审
doi:
更新日期:1993-11-01 00:00:00
abstract:AIMS:No-reflow after a primary percutaneous coronary intervention (PCI) is associated with a high incidence of left ventricular (LV) failure and a poor prognosis. Endothelin-1 (ET-1) is a potent endothelium-derived vasoconstrictor peptide and an important modulator of neutrophil function. Elevated systemic ET-1 levels ...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehl119
更新日期:2006-08-01 00:00:00
abstract::The clinical expert consensus statement on takotsubo syndrome (TTS) part II focuses on the diagnostic workup, outcome, and management. The recommendations are based on interpretation of the limited clinical trial data currently available and experience of international TTS experts. It summarizes the diagnostic approac...
journal_title:European heart journal
pub_type: 共识发展会议,杂志文章
doi:10.1093/eurheartj/ehy077
更新日期:2018-06-07 00:00:00
abstract::To determine if dobutamine-induced myocardial ischaemia causes abnormalities in Doppler parameters of left ventricular ejection and filling and to assess early effects of successful coronary angioplasty (PTCA) on these parameters, dobutamine stress echocardiography and Doppler studies were performed once in 11 normal ...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/14.8.1011
更新日期:1993-08-01 00:00:00
abstract:AIMS:To determine very long-term survival and incidence of recurrent interventions following aorto-coronary bypass surgery using venous grafts. METHODS AND RESULTS:A group of 1041 consecutive patients operated upon between 1971 and 1980 were followed for a median of 19 years (range 13-26). Peri-operative mortality was...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1053/euhj.1999.1867
更新日期:2000-05-01 00:00:00
abstract::Hypokalaemia commonly occurs in acute myocardial infarction (AMI) and may be caused by elevated serum levels of adrenaline, allegedly by beta 2-adrenergic mediated influx of potassium (K) into cells. We investigated the effect on serum K of intravenous acebutolol (a relatively beta 1-selective agent) in 50 patients wi...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a062036
更新日期:1986-02-01 00:00:00