Abstract:
:Large-scale randomized clinical trials have established the efficacy of cholesterol-lowering, blood pressure-lowering, and anti-platelet therapy to prevent cardiovascular diseases. A challenge for clinicians is to apply group-level evidence from these trials to individual patients. Trials typically report a single treatment effect estimate which is the average effect of all participants, comprising patients who respond poorly, intermediately, and well. Clinicians would preferably make patient-tailored treatment decisions. Therefore, one would require an estimate of an individual patient's response to therapy. Although not yet widely recognized, trials contain this type of information. In this paper, we show how available information from landmark trials can be translated to an individual 'treatment score' through the use of multivariable therapeutic prediction models. These models provide an individual estimate of the absolute risk reduction in cardiovascular events given the specific combination of multiple clinical characteristics of a patient under care. Based on this individualized treatment estimate and metrics such as the individual number-needed-to-treat, clinicians together with their patients can decide whether drug treatment or what treatment intensity is worthwhile. Selective treatment of those who can anticipate the greatest benefit and the least harm on an individualized basis could reduce the number of unnecessary treatments and healthcare costs beyond that currently achievable by subgroup analyses based on single patient characteristics.
journal_name
Eur Heart Jjournal_title
European heart journalauthors
van der Leeuw J,Ridker PM,van der Graaf Y,Visseren FLdoi
10.1093/eurheartj/ehu004subject
Has Abstractpub_date
2014-04-01 00:00:00pages
837-43issue
13eissn
0195-668Xissn
1522-9645pii
ehu004journal_volume
35pub_type
杂志文章abstract::The 18 month mortality rate in 2180 patients excluded from the Danish Verapamil Infarction Trail II (DAVIT II) was 25.6%. In non-consenters (n = 368) this was 15.0% compared with 13.85 in 897 placebo-treated patients (hazard ratio 1.09 [P = 0.60] when adjusting for sex and age). The increased mortality rate in exclude...
journal_title:European heart journal
pub_type: 临床试验,杂志文章
doi:10.1093/eurheartj/14.3.377
更新日期:1993-03-01 00:00:00
abstract::From 1978 to 1980, 260 healthy subjects, 40-79 years of age, underwent 24 h ambulatory electrocardiography in order to determine the prevalence and complexity of ventricular premature beats (VPBs) in adults without apparent heart disease. The number of types of VPBs seem in 5% or less were considered 'abnormal' and th...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a059946
更新日期:1991-05-01 00:00:00
abstract::Isolated quadricuspid aortic valve is very rare. The identification of this malformation can be made by cross-sectional echocardiography. Two cases of quadricuspid aortic valve diagnosed by cross-sectional echocardiography are described. ...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a062440
更新日期:1988-11-01 00:00:00
abstract::Falipamil hydrochloride (AQA 39) is a new antiarrhythmic agent structurally related to verapamil. We evaluated the electrophysiologic properties of intravenous falipamil (1.5 mg kg-1 within 20 minutes) in 12 patients. The spontaneous cycle length was significantly (P less than 0.001) prolonged (+79 +/- 59 ms). Atriove...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a062198
更新日期:1987-11-01 00:00:00
abstract:BACKGROUND:Myocardial ischaemia occurs principally in the subendocardial layer, whereas conventional myocardial perfusion imaging provides no information on the transmural myocardial blood flow (MBF) distribution. Subendocardial perfusion measurements and quantification of the transmural perfusion gradient (TPG) could ...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehu170
更新日期:2014-08-14 00:00:00
abstract::This report describes a patient with left atrial ball thrombus which was detected during echocardiographic evaluation of combined mitral-aortic valve disease. Surgical correction was performed entirely on the basis of the echocardiographic diagnosis. ...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a060161
更新日期:1992-02-01 00:00:00
abstract::Some studies provide a link between the width of QRS complexes and late potentials occurring at the end of the QRS complex in signal-averaged recordings. The purpose of this study was to compare three methods of QRS duration measurement: the conventional 12 lead ECG, the Frank vectorcardiogram (VCG) and the signal-ave...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a060375
更新日期:1994-01-01 00:00:00
abstract::The effects of the calcium antagonist, diltiazem (D), on left ventricular (LV) response to postextrasystolic potentiation (PESP) were investigated in 15 coronary artery disease patients. Several haemodynamic and LV function parameters, as well as regional wall kinetics, were analysed. During LV angiography, which was ...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a059772
更新日期:1990-07-01 00:00:00
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 mo...
journal_title:European heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/s0195-668x(03)00315-4
更新日期:2003-08-01 00:00:00
abstract:AIMS:Recent data from national registries suggest that acute heart failure (AHF) outcomes might vary in men and women, however, it is not known whether this observation is universal. The aim of this study was to evaluate the association of biological sex and 1-year all-cause mortality in patients with AHF in various re...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehaa071
更新日期:2020-04-01 00:00:00
abstract:AIMS:Brain natriuretic peptide (BNP), left ventricular (LV) systolic function, and mitral filling pattern (MFP) are prognostic indicators in patients with heart failure (HF). This study evaluated the potential role of E/Ea for predicting cardiovascular (CV) events in patients with suspected HF. This non-invasive measur...
journal_title:European heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1093/eurheartj/ehm647
更新日期:2008-02-01 00:00:00
abstract::A recent report of the EuroHeart project has shown that women are still underrepresented in many cardiovascular clinical trials, while important gender differences are present within most areas of heart disease. As the burden of cardiovascular disease is increasing in middle-aged women relative to men, a more profound...
journal_title:European heart journal
pub_type: 杂志文章,评审
doi:10.1093/eurheartj/ehr048
更新日期:2011-06-01 00:00:00
abstract::An inventory has been made of the practice of angioplasty in 14 European countries from 1985 onwards. The numbers of procedures performed varied in 1985 from 3 to 186 per million inhabitants, in 1991 from 52 to 716. All countries showed a steady increase, but the highest performer. Belgium, achieved only 55% of the nu...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/14.3.391
更新日期:1993-03-01 00:00:00
abstract::In a study of the concept of pacemaker dependence, 86 patients who had permanent ventricular demand (VVI) pacemakers implanted for more than six months and were in predominantly paced rhythm underwent repeated interruption of pacing both abruptly and after gradual reduction of paced rate. Non-invasive pace slowing was...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a061777
更新日期:1985-10-01 00:00:00
abstract::Patent foramen ovale (PFO) is implicated in the pathogenesis of a number of medical conditions but to date only one official position paper related to left circulation thromboembolism has been published. This interdisciplinary paper, prepared with the involvement of eight European scientific societies, reviews the ava...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehaa1070
更新日期:2021-01-28 00:00:00
abstract::The electrocardiographic patterns, observed during 24-h Holter monitoring, of 10 patients (mean age 35 +/- 22 years) with first and second degree A-V block due to dual A-V nodal pathways are reported. Recordings were selected according to the presence of: sudden and persistent prolongation of the PR interval: sudden n...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a059904
更新日期:1991-03-01 00:00:00
abstract::Pilots and new applicants with asymptomatic 'safe' WPW syndrome should be allowed to fly but not as pilot in sole command. Professional pilots with tachyarrhythmia related to a pre-excitation syndrome should usually be disqualified . Personnel who have undergone successful surgical treatment by ablation of an accessor...
journal_title:European heart journal
pub_type: 杂志文章,评审
doi:10.1093/eurheartj/5.suppl_a.119
更新日期:1984-03-01 00:00:00
abstract:AIMS:To assess compliance to guidelines in the management of patients with atrial fibrillation. METHODS AND RESULTS:A total of 728 questionnaires were mailed to physicians with the intention of studying 'theoretical' compliance to practice guidelines. A retrospective evaluation of 200 records from consecutive patients...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1053/euhj.2000.2300
更新日期:2001-10-01 00:00:00
abstract:AIMS:Recent data suggest that the administration of bone marrow-derived stem cells (BMSC) might improve myocardial perfusion and left ventricular (LV) function after acute myocardial infarction (AMI). The aim of this study was to assess spontaneous mobilization of BMSC expressing the haematopoietic and endothelial prog...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehi164
更新日期:2005-06-01 00:00:00
abstract::Health economics is about spending limited resources wisely and, as with so many fields in medicine, combines science with art and ingenuity. In order to know whether money is well spent it is necessary to have some reference points to make comparisons. Many accepted cardiovascular interventions, such as revasculariza...
journal_title:European heart journal
pub_type: 杂志文章,评审
doi:
更新日期:1998-12-01 00:00:00
abstract::Spinal cord electrical stimulation is an alternative therapy for patients with chronic pain syndromes including angina. Although it has been shown to produce symptomatic relief and reduce ischaemia, doubts remain about its long-term safety. We report here for the first time the results of a follow-up study over a peri...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a060589
更新日期:1994-06-01 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:AIMS:Elevated blood pressure (EBP) is the most prevalent and potentially modifiable risk factor for AF, yet little is known of its atrial effects. We aimed to characterize the atrial electrical and structural changes in a chronic ovine model of EBP after prenatal corticosteroid exposure. METHODS AND RESULTS:Twelve she...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehl360
更新日期:2006-12-01 00:00:00
abstract:AIMS:Takotsubo syndrome (TTS) is typically provoked by negative stressors such as grief, anger, or fear leading to the popular term 'broken heart syndrome'. However, the role of positive emotions triggering TTS remains unclear. The aim of the present study was to analyse the prevalence and characteristics of patients w...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehv757
更新日期:2016-10-01 00:00:00
abstract::Impaired relaxation of the ventricle has been described in hypertrophy and in ischemic heart disease. Some of these abnormalities are transient, but all occur at an early stage of the disease. The underlying mechanisms may vary depending on the etiology of the disease, and, except for ischemic heart disease, true myoc...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/4.suppl_a.43
更新日期:1983-01-01 00:00:00
abstract::Coronary revascularization procedures by means of percutaneous coronary interventions or coronary artery bypass graft surgeries are performed worldwide daily for the symptomatic treatment of patients with myocardial ischaemia. Nevertheless, angina remains a significant clinical problem. Management of angina recurring ...
journal_title:European heart journal
pub_type: 杂志文章,评审
doi:10.1093/eurheartj/ehl562
更新日期:2007-05-01 00:00:00
abstract:AIM:To evaluate the effect of alirocumab on frequency of standard apheresis treatments [weekly or every 2 weeks (Q2W)] in heterozygous familial hypercholesterolaemia (HeFH). METHODS AND RESULTS:ODYSSEY ESCAPE (NCT02326220) was a double-blind study in 62 HeFH patients undergoing regular weekly or Q2W lipoprotein aphere...
journal_title:European heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1093/eurheartj/ehw388
更新日期:2016-12-21 00:00:00
abstract::The class III antiarrhythmic drug dofetilide is known to prolong action potential duration by specific blockade of the delayed rectifier potassium channel Ik. As dofetilide is likely to be used in the treatment of atrial arrhythmias it is important to determine the relative sensitivity of the atrium and ventricle in m...
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.a060790
更新日期:1995-11-01 00:00:00
abstract:AIM:A genetic variant (rs20417) of the PTGS2 gene, encoding for COX-2, has been associated with decreased COX-2 activity and a decreased risk of cardiovascular disease (CVD). However, this genetic association and the role of COX-2 in CVD remain controversial. METHODS AND RESULTS:The association of rs20417 with CVD was...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehu168
更新日期:2014-09-01 00:00:00
abstract:AIMS:We estimated the association between outdoor light at night at the residence and risk of coronary heart disease (CHD) within a prospective cohort of older adults in Hong Kong. METHODS AND RESULTS:Over a median of 11 years of follow-up, we identified 3772 incident CHD hospitalizations and 1695 CHD deaths. Annual l...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehaa846
更新日期:2020-11-17 00:00:00