Abstract:
:High technology interventions near the end of life exact a high cost both in human and economic terms. Breathtaking advances in cardiology have helped to prolong life and improve its quality for many. For some, it has transformed the process of dying into a medical nightmare. The "do everything possible" attitude that prevailed during the past few decades is both inhumane and wasteful. In contrast, in the new era of managed care with its focus on profit, a well meaning physician may become suspect whenever he recommends against a medical intervention that he deems to be futile. More than ever before, there is a pressing need to develop rational guidelines for end of life medical interventions to ensure primacy of patients' best interests, protect the integrity of the doctor-patient relationship and affirm the duty of the medical establishment toward society at large. This weighty issue must not be relinquished to medical ethicists, health care alliances or the courts. It is the domain of physicians and the public at large. Medical futility should be defined as a treatment unlikely to affect the course of illness or that which has failed to achieve its desired effects. Rational guidelines for cardiopulmonary resuscitation and do not resuscitate orders should be formulated for both inhospital and out of hospital victims of cardiac arrest. These guidelines need to be developed through a process similar to those for the treatment of unstable angina, with involvement from all relevant medical specialities. Proposed guidelines must be negotiated, reviewed and ratified by the lay public. Appropriate legislation is necessary to establish the framework and policies to carry out agreed on recommendations. The focus of the "living will" should change so that it covers the last chapter of life rather than its terminal phase. The document should serve to express the person's wishes regarding specific medical interventions when the quality of life is seriously diminished beyond what is uniquely desirable for the particular patient. Living wills must be comprehensive, clear and specific. They must be honored. The Uniform Health Decisions Act, now pending legislation, should enhance the utility of the living will.
journal_name
J Am Coll Cardioljournal_title
Journal of the American College of Cardiologyauthors
Basta L,Tauth Jdoi
10.1016/s0735-1097(96)00341-5subject
Has Abstractpub_date
1996-11-15 00:00:00pages
1623-30issue
6eissn
0735-1097issn
1558-3597pii
S0735-1097(96)00341-5journal_volume
28pub_type
社论abstract:OBJECTIVES:The purpose of this study was to better understand the effects of long-term right ventricular pacing on left ventricular perfusion, innervation, function and histology. BACKGROUND:Long-term right ventricular apical pacing is associated with increased congestive heart failure and mortality compared with atri...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(94)90567-3
更新日期:1994-07-01 00:00:00
abstract:OBJECTIVES:The purpose of this analysis was to define the factors that predict 3-year graft patency. BACKGROUND:The success of coronary artery bypass graft surgery (CABG) is dependent on vein graft patency after the operation. It has been well established by a series of Department of Veterans Affairs Cooperative Trial...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(97)82539-9
更新日期:1997-06-01 00:00:00
abstract::The efficacy and safety of intravenous propafenone was studied in 10 patients with Wolff-Parkinson-White syndrome and in 2 patients with a concealed accessory pathway. During electrophysiologic study, the effect of propafenone on the effective refractory period of the accessory pathway was determined, as well as its e...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章
doi:10.1016/s0735-1097(87)80478-3
更新日期:1987-06-01 00:00:00
abstract::The feasibility of in vivo coronary angioscopy was tested utilizing a 1.8 mm angioscope in vessels where blood had been replaced by optically clear liquids, including a new perfluorocarbon emulsion. After trials in postmortem canine and human coronary arteries, in vivo intraluminal visualization was accomplished in th...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(83)80145-4
更新日期:1983-05-01 00:00:00
abstract::The complexity of the events that culminate in intimal proliferation after arterial injury and similarities between this response and benign neoplasia suggest that conventional medical therapies will continue to be unsuccessful in preventing recurrent stenosis after percutaneous coronary revascularization. By preventi...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/0735-1097(91)90948-9
更新日期:1991-05-01 00:00:00
abstract::Non-ST-segment elevation acute coronary syndromes (NSTE-ACS) are the leading cause of morbidity and mortality from cardiovascular disease worldwide. The American Heart Association/American College of Cardiology and the European Society of Cardiology periodically release practice guidelines to guide clinicians in the m...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/j.jacc.2016.03.599
更新日期:2016-07-19 00:00:00
abstract:OBJECTIVES:The goal of this study was to describe the prevalence and ablation of coronary sinus (CS) arrhythmias after left atrial ablation for atrial fibrillation (AF). BACKGROUND:The CS has been implicated in a variety of supraventricular arrhythmias. METHODS:Thirty-eight patients underwent mapping and ablation of ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2005.03.053
更新日期:2005-07-05 00:00:00
abstract::Pulsed Doppler echocardiography has been used previously to demonstrate marked changes in transvalvular blood flow velocities during cardiac tamponade in laboratory animals and a small number of patients. To further assess the respiratory changes in transvalvular blood flow during tamponade, pulsed Doppler tracings of...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/0735-1097(88)91533-1
更新日期:1988-03-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to demonstrate the feasibility and procedural outcomes with a new self-expanding and repositionable transcatheter heart valve. BACKGROUND:Transcatheter aortic valve replacement is a viable option for selected patients with severe symptomatic aortic stenosis. However, suboptimal...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2012.02.045
更新日期:2012-08-14 00:00:00
abstract:OBJECTIVES:We sought to demonstrate the prevalence, incidence and prognostic value of the Brugada-type electrocardiogram (ECG) in a general population. BACKGROUND:The Brugada syndrome is characterized by evidence of right bundle branch block and ST segment elevation in the right precordial leads, as well as sudden dea...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(01)01421-8
更新日期:2001-09-01 00:00:00
abstract:OBJECTIVES:The purpose of this study was to assess the ability of plasma B-type natriuretic peptide (BNP) to diagnose significant cardiovascular disease (CVD) in the pediatric population. BACKGROUND:BNP has been shown to be reliable in detecting ventricular dysfunction and heart failure in adults. Timely and accurate ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2009.06.020
更新日期:2009-10-06 00:00:00
abstract:OBJECTIVES:The purpose of this study was to determine the incidence of bleeding, vascular, and ischemic complications using three different heparin regimens after successful intervention. BACKGROUND:The ideal dose and duration of heparin infusion after successful coronary intervention is unknown. METHODS:Patients wer...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/s0735-1097(99)00195-3
更新日期:1999-08-01 00:00:00
abstract:OBJECTIVES:We sought to determine the predictive ability of troponin I (TnI) in a heterogeneous group of patients with chest pain admitted from the emergency department (ED) for exclusion of myocardial infarction (MI). BACKGROUND:Previous studies in high-risk patients demonstrated that troponin elevations are associat...
journal_title:Journal of the American College of Cardiology
pub_type: 评论,杂志文章
doi:10.1016/s0735-1097(00)00943-8
更新日期:2000-11-15 00:00:00
abstract:OBJECTIVES:The goal of this research was to determine the incremental cost and cost-effectiveness of embolic protection in patients undergoing percutaneous revascularization (PCI) of diseased saphenous vein bypass grafts (SVGs). BACKGROUND:Distal protection using the GuardWire balloon occlusion device has been shown t...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/j.jacc.2004.05.086
更新日期:2004-11-02 00:00:00
abstract:BACKGROUND:Previously, observational studies have identified associations between higher levels of dietary-derived antioxidants and lower risk of coronary heart disease (CHD), whereas randomized clinical trials showed no reduction in CHD risk following antioxidant supplementation. OBJECTIVES:The purpose of this study ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2020.10.048
更新日期:2021-01-05 00:00:00
abstract:OBJECTIVES:The study compared the adjusted risk for developing atrial fibrillation (AF) after minimally invasive direct coronary artery bypass surgery (MIDCAB) and coronary artery bypass graft surgery (CABG). BACKGROUND:Atrial fibrillation results in increased morbidity and delays hospital discharge after CABG. Recent...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(00)00974-8
更新日期:2000-11-15 00:00:00
abstract:OBJECTIVES:The objective of this investigation was to define for the first time the cardiorenal and humoral actions of repeated short-term administration of subcutaneous (SQ) brain natriuretic peptide (BNP) administration during the evolution of experimental heart failure. BACKGROUND:The rationale of this study was ba...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(00)00911-6
更新日期:2000-11-01 00:00:00
abstract:OBJECTIVES:We sought to examine the age and gender distribution of coronary artery calcium (CAC) by diabetes status in a large cohort of asymptomatic individuals. BACKGROUND:Among individuals with diabetes, coronary artery disease (CAD) is a major cause of morbidity and mortality. Electron-beam tomography (EBT) quanti...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(02)02975-3
更新日期:2003-03-19 00:00:00
abstract:BACKGROUND:Guidelines recommend that patients with heart failure with reduced ejection fraction (HFrEF) have medical therapy titrated to target doses derived from clinical trials, as tolerated. The degree to which titration occurs in contemporary U.S. practice is unknown. OBJECTIVES:This study sought to characterize l...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2019.02.015
更新日期:2019-05-21 00:00:00
abstract:OBJECTIVES:The purpose of this study was to evaluate the feasibility of measuring coronary flow velocity (CFV) by transthoracic Doppler echocardiography (TTDE) in the left anterior descending coronary artery (LAD) during contrast-enhanced dobutamine stress echocardiography (DSE). We also assessed the value of TTDE for ...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(01)01322-5
更新日期:2001-07-01 00:00:00
abstract:OBJECTIVES:Our aim was to measure the cardiac phosphocreatine to adenosine triphosphate ratio (PCr/ATP) noninvasively in patients and carriers of Xp21 muscular dystrophy and to correlate the results with left ventricular (LV) function as measured by echocardiography. BACKGROUND:Duchenne and Becker muscular dystrophy (...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(00)00960-8
更新日期:2000-11-15 00:00:00
abstract:OBJECTIVES:This study was designed to elucidate the location and mechanism of typical atrial flutter in the transplanted heart. BACKGROUND:Although the F wave morphology in atrial flutter is similar in nontransplanted and transplanted hearts, the surgical incision needed for the atrial anastomosis may create a distinc...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(97)00186-1
更新日期:1997-08-01 00:00:00
abstract:BACKGROUND:Intravascular volume expansion plays a major role in the prevention of contrast-induced acute kidney injury (CI-AKI). Recommended standard amounts of fluid infusion before procedures do not produce homogeneous responses in subjects with different initial hydration status. OBJECTIVES:The goal of this study w...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.jacc.2018.04.022
更新日期:2018-06-26 00:00:00
abstract:OBJECTIVES:We sought to evaluate the safety and efficacy of higher energy synchronized cardioversion in patients with atrial fibrillation refractory to standard energy direct current (DC) cardioversion. BACKGROUND:Standard external electrical cardioversion fails to restore sinus rhythm in 5% to 30% of patients with at...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(99)00463-5
更新日期:1999-12-01 00:00:00
abstract:OBJECTIVES:The purpose of this study is to determine if implantable cardioverter-defibrillator (ICD) implantation should be limited to physicians with high procedural volume. BACKGROUND:Expanding indications for ICDs will result in an increasing number of physicians implanting these devices. METHODS:Using the 20% Par...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2005.04.063
更新日期:2005-10-18 00:00:00
abstract:OBJECTIVES:This study investigated the ability of QT duration, QT dispersion (QTD) and clinical diagnostic criteria to correctly identify genetically documented LQT1 type long QT syndrome (LQTS) patients, and to separate symptomatic and asymptomatic LQT1 patients. BACKGROUND:Ventricular repolarization has played an es...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/s0735-1097(98)00248-4
更新日期:1998-08-01 00:00:00
abstract:OBJECTIVES:The goal of this study was to report a variety of atrial tachycardia that might be caused by an unusual electrophysiologic substrate. BACKGROUND:The mechanism of atrial tachycardias is attributed to re-entry, abnormal automaticity or triggered activity, based on their electropharmacological responses. A rat...
journal_title:Journal of the American College of Cardiology
pub_type: 临床试验,杂志文章
doi:10.1016/s0735-1097(00)00906-2
更新日期:2000-11-01 00:00:00
abstract:OBJECTIVES:The aim of this study was to determine the impact of the metabolic syndrome (MS) on operative mortality after a coronary artery bypass grafting surgery (CABG). BACKGROUND:Diabetes and obesity are highly prevalent among patients undergoing CABG. However, it remains unclear whether these factors have a signif...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2007.04.075
更新日期:2007-08-28 00:00:00
abstract::Pre-clinical diastolic dysfunction (PDD) has been broadly defined as left ventricular diastolic dysfunction without the diagnosis of congestive heart failure (HF) and with normal systolic function. PDD is an entity that remains poorly understood, yet has definite clinical significance. Although few original studies ha...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章,评审
doi:10.1016/j.jacc.2013.10.063
更新日期:2014-02-11 00:00:00
abstract:BACKGROUND:Pericardial effusion (PE) is common in cancer patients, but the optimal therapeutic approach is not well defined. Percutaneous pericardiocentesis is less invasive than surgery, but its long-term effectiveness and safety have not been well documented. OBJECTIVES:The goal of this study was to evaluate outcome...
journal_title:Journal of the American College of Cardiology
pub_type: 杂志文章
doi:10.1016/j.jacc.2015.06.1332
更新日期:2015-09-08 00:00:00