Evidence-Based Cardiology E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Evidence-Based Medicine
• Sprache: Englisch

Seitenzahl: 4265

Veröffentlichungsjahr: 2011

Beschreibung

Evidence based Cardiology was first published in 1998 to universal acclaim. Now, with the move towards more patient focused health care and at the same time increased emphasis on health economics, evidence-based practice is a more important force in health care delivery than ever. This new third edition, written by the world's leading cardiologists, provides graded evidence-based reviews of the major trials together with recommendations for optimum management, and now includes new grading and recommendation methodology. This is a unique book in the field of cardiology, and the largest evidence based clinical cardiology text.

Leseprobe

Contents

List of contributors

Preface to the third edition

Classification of recommendations and levels of evidence

List of abbreviations

Part I: General concepts and critical appraisal

Salim Yusuf, Editor

1 Evidence-based decision making: patient–physician interface

Philip J Devereaux, Marc Pfeffer, Salim Yusuf

Introduction

What is evidence-based medicine?

Approach to evidence-based clinical decision making

The varying roles of the components of evidence-based clinical decisions

Conclusion

References

2 Obtaining incremental information from diagnostic tests

Raymond J Gibbons

Clinical assessment

Approaches to the assessment of incremental value

Clinical significance and cost effectiveness

Conclusion

References

3 Clinical trials and meta-analysis

Jonathan R Emberson, Colin Baigent

Introduction

Clinical trials: minimizing biases and random errors

Large-scale meta-analysis

Can observational studies substitute for large-scale randomized trials/meta-analyses?

Conclusion

References

4 Understanding concepts related to health economics

Mark A Hlatky

Introduction

General concepts

Determination of costs

Estimation of costs

International perspectives

Cost-effectiveness analysis

Measuring effectiveness

Calculation of cost effectiveness

Patient selection and cost effectiveness

Diagnostic tests and cost effectiveness

Conclusion

References

5 Major vascular complications in patients undergoing non-cardiac surgery: magnitude of the problem, risk prediction, surveillance, and prevention

Philip J Devereaux, Matthew Chan, John Eikelboom

Magnitude of the problem

Preoperative risk prediction

Perioperative myocardial infarctions

Prevention of perioperative vascular complications

Take-away message from POISE

Conclusion

References

6 Implementing evidence-based medicine in cardiology

Brahmajee K Nallamothu, Thomas T Tsai, Jack V Tu

Introduction

Practice gaps, knowledge translation and quality improvement science

Practice gaps: scope of the problem

Barriers to knowledge translation

Strategies for quality improvement

Future directions

Conclusion

References

7 The application of evidence-based medicine to employment fitness standards: the transportation industries with special reference to aviation

Michael Joy

Introduction

The regulatory process

Modes of transport and regulation

The aviation environment

Aviation accident experience due to medical cause

Evidence-based medicine and workshops in aviation cardiology

The “1% rule” and best evidence

Specific cardiologic issues in aircrew

Conclusion

References

Part II: Prevention of cardiovascular diseases

Salim Yusuf and John A Cairns, Editors

8 Global perspective on cardiovascular disease

K Srinath Reddy

Introduction

Epidemiologic transition and the evolution of the CVD epidemic

Projections

Mechanisms which propel a cardiovascular disease epidemic in developing countries

Strategies to deal with the coronary epidemic

References

9 Avoidance of worldwide vascular deaths and total deaths from smoking

Prabhat Jha, Prem Mony, James Moore, Witold Zatonski

Introduction

Smoking trends

The health consequences of smoking

Interventions to reduce demand for tobacco

Effectiveness and cost effectiveness of tobacco control interventions

Comprehensive tobacco control programs

Conclusion

References

10 Tobacco and cardiovascular disease: achieving smoking cessation in cardiac patients

Andrew Pipe

Introduction

The pathophysiology of smoking and cardiovascular disease

The benefits of smoking cessation

Controling exposure to cigarette smoke

Nicotine addiction: the fundamental basis of smoking behavior

Smoking cessation: the fundamental preventive intervention

Conclusion

References

11 Lipids and cardiovascular disease

Malcolm Law

Introduction

Serum total and low-density lipoprotein cholesterol

Serum cholesterol and ischemic heart disease

The size of the effect

Dietary fat and serum cholesterol

Serum cholesterol and circulatory diseases other than ischemic heart disease

Triglycerides

High-density lipoprotein (HDL) cholesterol

Lipids as screening tests

Appropriate policy

Conclusion

References

12 Use of lipid-lowering agents in the prevention of cardiovascular disease

R Alan Failor, Jeffrey L Probstfield

Introduction

Use of individual lipid-altering agents

HMG-CoA reductase inhibitors (statins)

Nicotinic acid

Bile acid-sequestering agents (resins) (see Table 12.2)

Fibric acid derivatives (see Table 12.2)

Selective cholesterol absorption inhibitor

Novel agents

Combination therapy

Informed decisions about “gray zones”

Costs and cost effectiveness of lipid alterations for CHD prevention

Future directions

Conclusion

References

13 Blood pressure and cardiovascular disease

Curt D Furberg, Bruce M Psaty, Elsayed Z Soliman

Definition and classification

Prevalence

Natural history

Burden

Prevention of hypertension

Drug treatment

Genetics, hypertension, and some potential drug–gene interactions

Pharmacogenetics

Immunotherapy of hypertension

Cost effectiveness

Unanswered questions

References

14 Dysglycemia and the risk of cardiovascular events

Hertzel C Gerstein, Zubin Punthakee

Introduction

What is diabetes and how common is it?

How much does dysglycemia increase cardiovascular risk?

Explanation of the dysglycemia–cardiovascular disease connection

Does glucose lowering reduce cardiovascular outcomes?

Conclusion

References

15 Physical activity and exercise in cardiovascular disease prevention and rehabilitation

Ray W Squires

Introduction

Observational studies in the prevention of coronary heart disease

Cardiorespiratory fitness and coronary death

Exercise training in established coronary disease

Exercise training in chronic heart failure

Risks during acute exercise

How does habitual exercise decrease coronary risk?

Recommendations for types and amounts of physical activity and exercise for patients with cardiovascular diseases

Conclusion

References

16 Psychosocial factors

Annika Rosengren

Introduction

Potential mechanisms

Prospective studies

Psychosocial factors and prognosis in cardiovascular disease

Interventions

Conclusions and directions for the future

References

17 The social determinants of cardiovascular disease

Martin McKee, Clara K Chow

Introduction

Family networks

Social networks

The work environment

Mechanisms and interpretation

The broader environment

Conclusion

References

18 Obesity

Raj S Padwal, Arya M Sharma

Introduction and historical perspective

Nomenclature and definitions

Incidence, natural history and prognosis

Pathophysiology

Management

Conclusion

References

19 Ethnicity and cardiovascular disease

Clara K Chow, Sonia S Anand, Salim Yusuf

Introduction

General issues

Specific ethnic groups

Studies of multiple ethnic groups

Environmental contribution to ethnic and regional differences in cardiovascular disease

Genetic contribution to ethnic and regional differences in cardiovascular disease

Conclusion

References

20 Fetal origins of coronary artery disease

Katherine M Morrison, Stephanie Atkinson, Koon K Teo

Introduction

Atherosclerosis development in youth

Fetal health and cardiovascular risk factors and disease: evidence from retrospective studies

In utero influence on cardiovascular risk factor development in childhood: evidence from contemporary prospective birth cohorts

Development of risk due to postnatal factors

Underlying mechanisms

Implications for primary prevention of cardiovascular disease

References

21 Genetics of coronary heart disease

Michael S Cunnington, Bernard D Keavney

Evidence for genetic susceptibility to coronary heart disease

Genetic architecture of coronary heart disease susceptibility

Mendelian disorders associated with coronary artery disease

Family-based studies of non-Mendelian coronary heart disease: genome-wide linkage analysis

Single nucleotide polymorphisms and the human haplotype map

Candidate-gene association studies in coronary heart disease

Identification of lymphotoxin-alpha and galectin 2 by association study of 93000 single nucleotide polymorphisms

Genome-wide association studies of coronary heart disease endpoints

The chromosome 9p21 region: mechanistic clues and candidate genes

Genome-wide association studies of plasma lipids: new loci

“Mendelian randomization” studies: using genetics to identify causal emerging risk factors

Genetic testing in coronary heart disease: ready for “prime time”?

Low-frequency intermediate penetrance variants: still largely unknown territory

Pharmacogenetic studies in cardiovascular disease

Conclusion

Glossary of genetic terms used

References

22 Molecular genetics of cardiovascular disorders

Ali J Marian, Robert Roberts

Introduction

Mutations responsible for single gene disorders

Patterns of inheritance of single gene disorders

Family history and inherited cardiovascular disorders

Genetic counseling

Single gene cardiovascular disorders

Integration of genetics into routine clinical management

Polygenic or complex disorders

New technology

Genetics and future therapy

References

23 Diet and cardiovascular disease

K Srinath Reddy

Introduction

Methodologic issues in the study of causal associations

Nutrients and cardiovascular disease

Minerals: blood pressure and cardiovascular disease

Food items and food groups

Dietary patterns and composite dietary interventions

Implications for policy

References

24 Integrating approaches to prevention of cardiovascular disease

David A Wood, Kornelia Kotseva

Introduction and historical perspective

Nomenclature and definitions

Incidence, natural history, and prognosis

Management

The EUROACTION Preventive Cardiology Program in hospital and general practice

The Polypill concept

Summary

References

Part IIIa: Stable coronary artery disease

John A Cairns and Bernard J Gersh, Editors

25 Medical management of stable coronary artery disease

William E Boden

Introduction

Epidemiology

Definition and classification

Pathophysiology

Medical management of myocardial ischemia

Role of myocardial revascularization

Recommended initial management approach in stable coronary artery disease patients with angina

Conclusion

References

26 Percutaneous intervention

David A Wood, Rohit Khurana, Christopher E Buller

Introduction

Principles and historic overview

Percutaneous coronary intervention technology

Vascular access

Technology and pharmacology trials of percutaneous coronary intervention in stable coronary artery disease

Strategic trials of percutaneous coronary intervention versus medical therapy in stable coronary artery disease

Conclusions: elective percutaneous coronary intervention versus medical therapy (Boxes 26.5 and 26.6)

Future directions and challenges

References

27 Surgical coronary artery revascularization

Morgan L Brown, Thoralf M Sundt III

Introduction and historic perspective

Incidence, natural history, and prognosis

Management

Techniques

Conclusion

References

28 Comparisons of percutaneous coronary intervention and coronary artery bypass grafting

Arashk Motiei, Thoralf M Sundt III, Charanjit S Rihal

Introduction

The effectiveness of coronary artery bypass graft surgery versus medical therapy (see also Chapter 27)

The effectiveness of percutaneous coronary intervention

Comparisons of percutaneous coronary intervention versus coronary artery bypass graft

Coronary artery bypass graft versus percutaneous coronary intervention in diabetic patients

Conclusions and recommendations

References

Part IIIb: Acute coronary syndromes

John A Cairns and Bernard J Gersh, Editors

29 Non-ST segment elevation acute coronary syndromes: unstable angina and non-ST segment elevation myocardial infarction

Pierre Theroux, John A Cairns

Introduction and historic perspective

New dimensions and definitions

Clinical diagnosis

Incidence, natural history and prognosis

Risk stratification

Clinical features

Risk scores

Pathophysiology

Management

Conclusion

References

30 Early prehospital management of ST segment elevation myocardial infarction

Robert C Welsh, Paul W Armstrong

Introduction

Patient symptom recognition, public education strategies and activation of the prehospital emergency medical system

Prehospital diagnosis of ST elevation myocardial infarction

Prehospital management of ST elevation myocardial infarction

Integration of prehospital strategies in a system-wide reperfusion program

Conclusion

References

31 Reperfusion therapies for ST segment elevation myocardial infarction

Joseph B Muhlestein, Jeffrey L Anderson

Introduction

Historic perspective

Fibrinolytic agents

Conclusion

References

32 Antithrombotic therapies for patients with ST segment elevation myocardial infarction

Andrew J Lucking, Keith A A Fox

Introduction

Antiplatelet agents

Anticoagulant therapy

Conclusion

References

33 Complications after myocardial infarction

Peter L Thompson

Introduction

Reinfarction, extension and expansion of infarction

Left ventricular dysfunction and pulmonary congestion

Cardiogenic shock

Right ventricular infarction and failure

Left ventricular aneurysm

Free wall rupture

Pericarditis

Cardiac thromboembolism

Acute mitral regurgitation

Ventricular septal rupture

Ventricular fibrillation and sustained ventricular tachycardia

Postinfarction ventricular premature beats and non-sustained ventricular tachycardia

Atrial fibrillation

Heart block and conduction disturbances

Psychosocial complications

References

34 An integrated approach to the management of patients after the early phase of ST segment elevation myocardial infarction

Pedro L Sánchez, Francisco Fernández-Avilés

Introduction

Invasive evaluation after the early phase of STEMI

Preventing cardiac remodeling

Preventing arrhythmic complications

Secondary prevention

Evidence-based integrated approach to management of patients after the early phase of STEMI

References

Part IIIc: Arrhythmias

A John Camm and John A Cairns, Editors

35 Atrial fibrillation: rhythm and rate control therapies

Irina Savelieva, Albert L Waldo, A John Camm

Introduction

Principles of therapy

Studies of rate and rhythm control strategies

Pharmacologic cardioversion for atrial fibrillation

Antiarrhythmic drugs and electrical cardioversion

New agents for pharmacologic cardioversion

Prevention of atrial fibrillation

Where to initiate antiarrhythmic drug therapy

Antiarrhythmic drug use after left atrial ablation

Pharmacologic rate control

Atrial fibrillation after cardiac surgery

Conclusion

References

36 Atrial fibrillation: upstream therapies

Antonios Kourliouros, Irina Savelieva, Marjan Jahangiri, A John Camm

Introduction

Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers for the prevention of atrial fibrillation

ACEIs and ARBs for the prevention of AF in patients with heart failure

Statins for the prevention and treatment of atrial fibrillation

N-3 polyunsaturated fatty acids for the prevention of atrial fibrillation

Corticosteroids for the prevention of atrial fibrillation

Conclusion

References

37 Atrial fibrillation: antithrombotic therapy

John A Cairns, Stuart Connolly

Definitions, incidence and natural history

Antithrombotic management

Rate versus rhythm control

Choice of antithrombotic therapy

Cardioversion

Atrial flutter

Atrial fibrillation and coronary artery disease

Interruption of warfarin therapy in relation to surgical procedures

Conclusion and recommendations

References

38 Ablation therapy for atrial fibrillation

Conor D Barrett, Chi Keong Ching, Luigi Di Biase, Claude S Elayi, David J Burkhardt, Rodney Horton, Andrea Natale

Introduction

Advantages of rhythm control

Inadequacy of non-ablative rhythm control

Catheter ablation of atrial fibrillation

Randomized controlled trials of catheter ablation for atrial fibrillation

Non-randomized trials of atrial fibrillation ablation in patient subgroups

Complications of catheter ablation of atrial fibrillation

Conclusion

References

39 Supraventricular tachycardia

Erica D Penny-Peterson, Gerald V Naccarelli

Introduction

Sinus tachycardia

Atrial tachycardia

Atrial flutter

AV nodal re-entrant tachycardia

Automatic junctional tachycardia

Atrioventricular reciprocating tachycardia

References

40 Prevention and treatment of life-threatening ventricular arrhythmia and sudden death

Carlos A Morillo, Adrian Baranchuk

Introduction

Suppression of ventricular a rrhythmias and sudden cardiac death

Beta-blockers and prevention of sudden cardiac death

Upstream therapy and prevention of sudden cardiac death

Implantable cardioverter-defibrillators for prevention of sudden cardiac death

References

41 Pacemaker therapy, including cardiac resynchronization therapy

William D Toff, A John Camm

Introduction and historical perspective

Goals of cardiac pacing

Current pacing practice

Conventional indications for pacing

Mode selection in AV block and sinus node disease

A new paradigm for physiologic pacing

New indications for pacing Neurocardiogenic syncope

Cardiac resynchronization therapy

Future perspectives

References

42 Syncope

David G Benditt, Fei Lu, Scott Sakaguchi

Introduction

Nomenclature

Incidence, natural history, and prognosis

Pathophysiology

Diagnosis

Cost-effectiveness issues

Conclusion

Acknowledgment

References

43 Cardiopulmonary resuscitation

Michael Colquhoun

Introduction

Establishing an evidence base for resuscitation practice

Adult basic life support

Advanced life support: defibrillation

Advanced life support: other considerations

Techniques and devices to assist the circulation during cardiac arrest

Conclusion

References

44 Arrhythmias due to monogenic disorders

Dawood Darbar, Prince Kannankeril, Dan M L Roden

Introduction

What we have learned from the genetics of monogenic arrhythmia syndromes

Complexity beyond monogenic arrhythmia disorders

Atrial fibrillation

Monogenic forms of lone AF

Atrial flutter

Sinus nodal failure

Other atrial arrhythmias

Ventricular arrhythmias

Conclusion

References

45 Arrhythmiagenic right ventricular cardiomyopathy

Deirdre Ward, Perry M Elliott

Introduction

History

Epidemiology

Pathology

Genetics

Natural history

Clinical features

Diagnosis

Management

Future directions

References

Part IIId: Specific cardiovascular disorders: left ventricular dysfunction

Salim Yusuf, Editor

46 Epidemiology and prevention of heart failure and management of asymptomatic left ventricular systolic dysfunction

J Paul Rocchiccioli, John J V McMurray

Epidemiology of heart failure

Epidemiology of asymptomatic left ventricular systolic dysfunction

Etiology of heart failure

Preventive strategies

Management of asymptomatic left ventricular systolic dysfunction

Conclusion

References

47 Management of overt heart failure

Paul J Hauptman, Karl Swedberg

Introduction

Pharmacologic therapy

Device and surgical therapy

Heart failure with preserved left ventricular function

Challenges and controversies

Conclusion

References

48 Acute myocarditis and dilated cardiomyopathy

Leslie T Cooper Jr, Oyere K Onuma

Introduction and historic perspectives

Incidence, natural history and prognosis of acute myocarditis

Pathogenesis of myocarditis

Clinical presentation and diagnosis

Management

Specific therapy

Specific etiologies of myocarditis and their management

Conclusion

References

49 Management of hypertrophic cardiomyopathy

Barry J Maron

Prevalence and epidemiology

Definition and nomenclature

Left ventricle morphology

Genetics

Symptoms

Natural history

Risk stratification and sudden cardiac death

Management

Conclusion

References

50 Infective and infiltrative cardiomyopathies

Stavros Kounas, Perry M Elliott

Infective cardiomyopathies

Infiltrative cardiomyopathies

References

51 Chagas’ heart disease

J Antonio Marin-Neto, Anis Rassi Jr,

Benedito Carlos Maciel, Marcus Vinicius Simões,

André Schmidt

Historical perspective

Definitions

Epidemiology

Natural history and prognostic factors

Pathophysiology and pathogenetic mechanisms

Clinical features

Management

Prevention

References

Part IIIe: Specific cardiovascular disorders: pericardial disease

Bernard J Gersh, Editor

52 Pericardial disease: an evidence-based approach to clinical management

Faisal F Syed, Bongani M Mayosi

Introduction

Idiopathic pericarditis

Purulent pericarditis

Tuberculous pericarditis

Neoplastic pericarditis

References

Part IIIf: Specific cardiovascular disorders: valvular heart disease

Bernard J Gersh, Editor

53 Rheumatic heart disease: prevention and acute treatment

Bongani M Mayosi, Patrick J Commerford

Introduction

Epidemiology

Pathogenesis

Clinical features

Prevention

Acute management

Conclusion

References

54 Mitral valve disease: indications for surgery

Blase A Carabello

Introduction

Mitral regurgitation

Mitral stenosis

References

55 Surgical indications in aortic valve disease

Sunil Mankad, Heidi M Connolly,

Shahbudin H Rahimtoola

Introduction

Aortic valve stenosis

Chronic aortic valve regurgitation

Conclusion

References

56 Non-surgical aortic valve therapy: balloon valvuloplasty and transcatheter aortic valve replacement

Robert H Boone, John G Webb

Introduction

Pathophysiology and natural history

Aortic valve replacement indications and risk

Balloon valvuloplasty

Transcatheter heart valve

Non-surgical aortic valve therapy compared

Conclusion

References

57 Balloon valvuloplasty: mitral valve

Zoltan G Turi

Introduction and historical perspective

The percutaneous approach

Mechanism of balloon commissurotomy and Pathophysiology

Transesophageal echocardiography

Cardiac catheterization

Contraindications

Procedure

Alternative techniques

Balloon Versus Open and Closed Surgical Commissurotomy

Restenosis

Complications

Postprocedure management

Conclusion

References

58 Valve repair and choice of valve

Shafie S Fazel, Tirone E David

Introduction

Nomenclature and definitions

Natural history and indications for surgery

Valve repair

Valve replacement

Conclusion

References

59 Infective endocarditis

Zainab Samad, Andrew Wang

Introduction and historical perspective

Nomenclature

Incidence and epidemiology

Pathogenesis

Diagnosis

Treatment

Complications and outcome

Prevention

References

60 Antithrombotic therapy after heart valve replacement

Jack C J Sun, John W Eikelboom

Introduction and historical perspective

Nomenclature and definitions

Incidence, natural history and prognosis

Pathophysiology

Antithrombotic therapy

Conclusion

References

Part IIIg: Specific cardiovascular disorders: other conditions

Bernard J Gersh and Salim Yusuf, Editors

61 Stroke

Brian H Buck, Ashfaq Shuaib, Craig Anderson

Management of acute ischemic stroke

Secondary prevention of stroke

References

62 Heart disease and pregnancy

Rachel M Wald, Samuel C Siu

Introduction

Cardiovascular physiology and pregnancy

Outcomes associated with specific cardiac lesions

Management

Conclusion

References

63 Adult congenital heart disease

Elisabeth Bédard, Michael A Gatzoulis

Introduction: prevalence of congenital heart disease

Etiology

Atrial septal defect

Ventricular septal defect

Atrioventricular septal defect

Left ventricular outflow tract obstruction and bicuspid aortic valve

Coarctation of the aorta

Patent ductus arteriosus

Pulmonary valve stenosis

Ebstein anomaly of the tricuspid valve

Tetralogy of Fallot

Transposition of the great arteries

Eisenmenger syndrome

Arrhythmias in adult congenital heart disease

References

64 Venous thromboembolic disease

Lori-Ann Linkins, Clive Kearon

Introduction and historical perspective

Nomenclature and definitions

Incidence, natural history and prognosis

Pathophysiology

Diagnosis

Treatment

Prevention

Conclusion

References

65 Peripheral arterial disease

Catherine McGorrian, Sonia S Anand

Introduction

Epidemiology and natural history

Risk factors

Diagnosis

Therapeutics

Special considerations: critical limb ischemia and acute l imb ischemia

Conclusion

References

66 Cardiac risk in those undergoing non-cardiac surgery

Ameeth Vedre, Kim A Eagle

Introduction and historical perspective

Assessment of preoperative risk for non-cardiac surgery

General approach to the patient

Perioperative beta-blocker therapy

Perioperative statin therapy

References

67 Clinical management of diseases of the aorta

Thoralf M Sundt III

Introduction

Nomenclature and definitions

Incidence

Natural history and prognosis

Diagnosis

Management

Conclusion

References

68 Cardiac transplantation: indications and postoperative management

Barry Boilson, Sudhir Kushwaha

Historical perspective

Outcomes

Recipient selection

Donor selection

Operative details

Postoperative course

Complications

LVADs as long-term cardiac replacement therapy

Conclusion

References

69 Renal dysfunction

Johannes F E Mann, Ernesto L Schiffrin

Definition of chronic kidney disease

When to measure eGFR and urinary protein excretion?

Population-wide impact of cardiovascular risk associated with renal dysfunction

Why are low GFR and proteinuria risk factors for vascular disease?

Implications for therapy

References

70 Pulmonary hypertension

Brendan P Madden

Introduction

Pathology

Survival

Quality of life

Natural history

Diagnosis

Physical examination

Routine investigations

Evidence for diagnostic tests in patients with suspected pulmonary arterial hypertension

Genetic aspects

Current theories on the pathophysiology of pulmonary arterial hypertension

Therapeutic targets

Therapeutic options

Special circumstances

Conclusion

References

Part IV: Clinical applications

Ernest L Fallen, Editor

71 Clinical applications of external evidence

Ernest L Fallen, Salim Yusuf

Evidence-based versus patient-centered medicine? Not an either/or choice

Recognizing the limitations of external evidence

Recognizing the limitations of patient-centered medicine

Some principles of application

Section preview

References

72 Stable angina: choice of PCI versus CABG versus drugs

William S Weintraub

Conclusion

References

73 Non-ST segment acute coronary syndrome

David Fitchett

References

74 Acute ST segment elevation myocardial infarction

Ernest L Fallen

Conclusion

References

75 Secondary prevention strategies post myocardial infarction

Jacques Genest

Conclusion

References

76 Heart failure

Michael M Givertz, Garrick C Stewart

Question

Comment

Question

Comment

Question

Comment

Question

Comment

References

77 Atrial fibrillation

Michael Klein

Question

Comment

Question

Comment

Question

Comment

References

78 The case for and against implantable cardioverter defibrillators in patients with coronary artery disease

Jeffrey S Healey

Question

Comment

Comment

Comment

Conclusion

References

79 Bradyarrhythmias – choice of pacemakers

Pablo B Nery, Carlos A Morillo

Question

Comment

Question

Comment

Conclusion

References

80 Peripheral arterial disease with suspect coronary artery disease

Victor Aboyans, Michael H Criqui

Question

Comment

Question

Comment

References

81 Valvular heart disease: timing of surgery

Jon-David R Schwalm, Victor Chu

Question

Comment

Question

Comment

Question

Comment

References

Index

The colour plate section can be found facing

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Library of Congress Cataloging-in-Publication Data

Evidence-Based Cardiology/edited by Salim Yusuf… [et al.]. – 3rd ed.p.; cm.Includes bibliographical references and index.ISBN 978-1-4051-5925-8 (alk. paper)

1. Heart–Diseases–Handbooks, manuals, etc. 2. Evidence-based medicine–Handbooks, manuals, etc. I. Yusuf, Salim, 1952–[DNLM: 1. Cardiovascular Diseases–therapy. 2. Cardiology–methods. 3. Evidence-Based Medicine–methods.WG 166 E93 2010]

RC669.15.S53 2010

616.1’2–dc22

2009026216

ISBN: 978-1-4051-5925-8

A catalogue record for this book is available from the British Library. Set in 9.5 on 12 pt Palatino by SNP Best-set Typesetter Ltd., Hong Kong

List of contributors

Victor Aboyans MD, PhD

Hospital Physician, Department of Thoracic and Cardiovascular Surgery, and Angiology, Dupuytren University Hospital, Limoges, France

Sonia S. Anand MD, PhD, FRCPC

Professor of Medicine, McMaster University, Hamilton, Ontario, Canada

Jeffrey L. Anderson MD, FACC, FAHA, MACP

Professor of Internal Medicine, University of Utah School of Medicine; Associate Chief of Cardiology and Vice Chair for Research, Intermountain Medical Center, Salt Lake City, UT, USA

Craig Anderson MBBS, PhD, FRACP, FAFPHM

Director, Neurological and Mental Health Division, Professor of Stroke Medicine and Clinical Neuroscience, The George Institute for International Health, University of Sydney and the Royal Prince Alfred Hospital, Sydney, Australia

Paul W. Armstrong MD

Distinguished University Professor, University of Alberta, Edmonton, Alberta, Canada

Stephanie Atkinson PhD

Professor and Associate Chair (Research), Department of Pediatrics, Associate Member, Department of Biochemistry and Biomedical Science, McMaster University, Hamilton, Ontario, Canada

Colin Baigent BM, BCh, FFPH, FRCP

Professor of Epidemiology, University of Oxford, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Oxford, UK

Adrian Baranchuk MD

Kingston General Hospital, Queen’s University, Kingston, Ontario, Canada

Conor D. Barrett MD

Instructor in Medicine, Harvard Medical School, Cardiac Arrhythmia Service, Massachusetts General Hospital Heart Center, Boston, MA, USA

Elisabeth Bédard MD

Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, UK

David G. Benditt MD, FACC, FRCPC, FHRS

Professor of Medicine, Co-Director, Cardiac Arrhythmia Center, University of Minnesota Medical School, Minneapolis, MN, USA

William E. Boden MD, FACC

Professor of Medicine and Preventive Medicine, University at Buffalo, School of Medicine and Public Health; Clinical Chief, Division of Cardiovascular Medicine, University at Buffalo; Chief of Cardiology, Buffalo General and Millard Fillmore Hospitals, Buffalo, NY, USA

Barry A. Boilson MD, MRCPI

Fellow in Cardiac Transplantation Medicine, Mayo Clinic, Rochester, MN, USA

Robert H. Boone MD, FRCPC, MSc(Epi)

Clinical Assistant Professor, Interventional Cardiology, St. Paul’s Hospital, Providence Health Care, University of British Columbia, Vancouver, BC, Canada

Morgan L. Brown MD

Research Fellow, Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA

Brian H. Buck MD, MSc, FRCPC

Assistant Professor, Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

Christopher E. Buller MD, FRCPC

Professor of Medicine, University of British Columbia; Head, Division of Cardiology, Vancouver General Hospital, Vancouver, BC, Canada

David J. Burkhardt MD

Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA

John A. Cairns MD, FRCPC

Professor of Medicine and Former Dean, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

A. John Camm MD

British Heart Foundation Professor of Clinical Cardiology, Head of Cardiac and Vascular Sciences, St George’s University of London, London, UK

Blase A. Carabello MD

Professor of Medicine, Vice-Chairman, Department of Medicine, WA Tex and Deborah Moncrief Jr. Center, Baylor College of Medicine, Medical Care Line Executive, Veterans Affairs Medical Center, Houston, TX, USA

Matthew Chan FANZCA

Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China

Chi Keong Ching MBBS, MRCP (UK)

Consultant Cardiologist and Electrophysiologist, Department of Cardiology, National Heart Centre Singapore, Mistri Wing, Singapore

Clara K. Chow MBBS, FRACP, PhD

Senior Research Fellow, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada

Victor Chu MD, FRCS(C)

McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada

Michael Colquhoun BSc, FRCP, MRCGP

Honorary Lecturer, School of Medicine, Cardiff University, Cardiff, UK

Patrick J. Commerford MD

Cardiac Clinic, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa

Stuart J. Connolly MD, FRCPC

Director, Division of Cardiology, McMaster University, Hamilton, Ontario, Canada

Heidi M. Connolly MD

Professor of Medicine, Mayo Clinic, Rochester, MN, USA

Leslie T. Cooper Jr MD

Professor of Medicine, Mayo Clinic College of Medicine; Chief, Section of Vascular Medicine, Mayo Clinic, Rochester, MN, USA

Michael H. Criqui MD, MPH

Professor and Chief, Division of Preventive Medicine, Department of Family and Preventive Medicine, University of California, San Diego School of Medicine, La Jolla, CA, USA

Michael S. Cunnington BMedSci, MB BS (Hons), MRCP

British Cardiovascular Society/Swire Research Fellow, Institute of Human Genetics, Newcastle University, Newcastle-upon-Tyne, UK

Dawood Darbar MBChB, MD, FACC

Associate Professor of Medicine and Pharmacology, Director, Vanderbilt Arrhythmia Service, Vanderbilt University School of Medicine, Nashville, TN, USA

Tirone E. David MD

Professor of Surgery, University of Toronto, Head of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Canada

Philip J. Devereaux MD, PhD, FRCP(C)

Departments of Clinical Epidemiology and Biostatistics and Medicine, McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada

Luigi Di Biase MD

Electrophysiologist Research Fellow, Department Dean of Medicine, University of Texas Medical Branch at Austin, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA; Department of Cardiology, University of Foggia, Foggia, Italy

Kim A. Eagle MD, MACC

Albion Walter Hewlett Professor of Internal Medicine, Chief of Clinical Cardiology, Director, Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA

John Eikelboom MBBS, MSc, FRACP, FRCPA, FRCPC

Associate Professor, Department of Medicine, McMaster University, Hamilton, Ontario, Canada

Claude S. Elayi MD

Assistant Professor of Medicine, Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, KY, USA

Perry M. Elliott MBBS, MD, FRCP

Reader in Inherited Cardiac Disease, University College London, London, UK

Jonathan R. Emberson BA, MSc, PhD

Senior Statistician, University of Oxford, Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), Oxford, UK

R. Alan Failor MD

Clinical Professor of Medicine, Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA

Ernest L. Fallen MD, FRCPC

Professor Emeritus, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada

Shafie S. Fazel MD, PhD

Senior Resident, Division of Cardiac Surgery, Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto, Toronto, Canada

Francisco Fernández-Avilés PhD, MD

Professor of Medicine, Head of the Department of Cardiology, Hospital General Universitario Gregorio Marañón, Complutense University, School of Medicine, Madrid, Spain

David Fitchett MD, FRCPC

Director, Cardiac ICU, St. Michael’s Hospital Toronto, Associate Professor of Medicine, University of Toronto, Toronto, Ontario, Canada

Keith A. A. Fox BSc (Hons) MBChB, FRCP, FESC, FMedSci, FACC

FACC Professor of Cardiology, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK

Curt D. Furberg MD, PhD

Professor, Division of Public Health Sciences, Wake Forest University School of Medicine, WinstonSalem, NC, USA

Michael A. Gatzoulis MD, PhD, FACC, FESC

Professor of Cardiology, Congenital Heart Disease and Consultant Cardiologist, Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, and the National Heart & Lung Institute, Imperial College, London, UK

Jacques Genest Jr MD, FRCPC

Professor, Faculty of Medicine, McGill University, Novartis Chair in Medicine at McGill University, Director, Division of Cardiology University Health Center/ Royal Victoria Hospital, Montreal, Quebec, Canada

Bernard J. Gersh MB, ChB, DPhil

Consultant in Cardiovascular Diseases and Internal Medicine, Mayo Clinic; Professor of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA

Hertzel C. Gerstein MD, MSc, FRCPC

Division of Endocrinology and Metabolism, Population Health Research Institute, Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada

Raymond J. Gibbons MD

Arthur M. and Gladys D. Gray Professor of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA

Michael M. Givertz MD

Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

Paul J. Hauptman MD

Professor of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO, USA

Jeffrey S. Healey MD, MSc, FRCP(C)

Associate Professor of Medicine, McMaster University, Hamilton, Ontario, Canada

Mark A. Hlatky MD

Professor of Health Research and Policy & Professor of Medicine (Cardiovascular Medicine), Stanford University School of Medicine, Stanford, CA, USA

Rodney Horton MD

Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA

Marjan Jahangiri FRCS

Professor of Cardiac Surgery, Department of Cardiothoracic Surgery, St. George’s University of London, London, UK

Prabhat Jha MD, DPhil

Centre for Global Health Research, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada

Michael Joy OBE, MD, FRCP, FACC, FESC, FRAeS

Professor of Clinical Cardiology, Postgraduate Medical School, Surrey University, Guildford, and, Cardiologist, Medical Department, UK Civil Aviation Authority, West Sussex, UK

Prince Kannankeril MD, MSCI

Assistant Professor, Vanderbilt, Department of Pediatrics, University Medical Centre, Nashville, TN, USA

Clive Kearon MB, MRCPI, FRCPC, PhD

Professor of Medicine, McMaster University, Hamilton, Ontario, Canada

Bernard D. Keavney MD

Professor of Cardiology, Institute of Human Genetics and Department of Cardiology, Newcastle University, Newcastle-upon-Tyne, UK

Rohit Khurana BMBCh, PhD, MRCP

Fellow, Interventional Cardiology, Vancouver General Hospital, Division of Cardiology, University of British Columbia, Vancouver, BC, Canada

Michael Klein MD

Clinical Professor of Medicine, Boston University, School of Medicine, Boston, MA, USA

Kornelia Kotseva MD, PhD, FESC

Senior Clinical Research Fellow, Consultant Cardiologist, Cardiovascular Medicine, National Heart and Lung Institute, Imperial College, London, UK

Stavros Kounas MD

The Heart Hospital, University College London, London, UK

Antonios Kourliouros MD

Department of Cardiothoracic Surgery, St George’s University of London, London, UK

Sudhir Kushwaha MD

Associate Professor of Medicine, Mayo Clinic, Rochester, MN, USA

Malcolm Law FRCP, FMedSci

Professor of Epidemiology and Preventive Medicine, Centre for Environmental and Preventive Medicine, Queen Mary School of Medicine and Dentistry, Wolfson Institute of Preventive Medicine, London, UK

Lori-Ann Linkins MD, MSc, FRCPC

Associate Professor, McMaster University, Thromboembolism/Hematology, Hamilton, Ontario, Canada

Fei Lu MD, PhD, FACC, FHRS

Associate Professor of Medicine, Director, Cardiac Electrophysiology Laboratories, Cardiac Arrhythmia Center, University of Minnesota Medical School, Minneapolis, MN, USA

Andrew J. Lucking BMedSci(Hons), MBChB(Hons), MRCP

Clinical Research Fellow, University of Edinburgh, Edinburgh, UK

Benedito Carlos Maciel MD

Full Professor of Medicine, Division of Cardiology, Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil

Brendan P. Madden MD, MSc, FRCPI, FRCP

Professor of Cardiothoracic Medicine, St George’s Hospital, London, UK

Sunil Mankad MD

Associate Professor of Medicine, Mayo Clinic College of Medicine, Director, Transesophageal Echocardiography, Co-Director, Education, Echocardiography, Mayo Clinic, Rochester, MN, USA

Johannes F. E. Mann MD

Professor of Medicine, Friedrich Alexander University of Erlangen, Head, Department of Nephrology and Hypertension, Schwabing General Hospital, Ludwig Maximilians University, Munich, Germany

Ali J. Marian MD

Professor of Molecular Medicine and Internal Medicine (Cardiology), Director, Center for Cardiovascular Genetics, Institute of Molecular Medicine, The University of Texas Health Science Center, Houston, TX, USA

J. Antonio Marin-Neto MD, PhD, FACC

Full Professor of Medicine and Director, Cardiology Division, Department of Internal Medicine, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil

Barry J. Maron MD

Director, Hypertrophic Cardiomyopathy Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA

Bongani M. Mayosi DPhil, FCP(SA)

Professor of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa

Catherine McGorrian MB, BCh, BAO, MRCPI

Clinical Fellow, Department of Medicine, McMaster University, Hamilton, Ontario, Canada

Martin McKee MD, DSc, FRCP, FRCPI, FFPH, FMedSci, CBE

Professor, European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK

John J.V. McMurray MD

Professor of Medical Cardiology, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK

Prem Mony MD

CIHR Canada-HOPE Scholar, Centre for Global Health Research, St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada

James Moore

Bill and Melinda Gates Foundation, New Delhi, India

Carlos A. Morillo MD, FRCPC, FACC, FHRS, FESC

Professor, Department of Medicine, Director Arrhythmia & Pacing Service, McMaster University, Hamilton, Ontario, Canada

Katherine M. Morrison MD, FRCPC

Associate Professor, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada

Arashk Motiei MD

Fellow in Cardiovascular Diseases, Mayo School of Graduate Medical Education, Mayo Clinic College of Medicine, Rochester, MN, USA

Joseph B. Muhlestein MD, FACC

Professor of Medicine, University of Utah; Director, Cardiology Research, Intermountain Medical Center, Murray, UT, USA

Gerald V. Naccarelli MD

Bernard Trabin Chair in Cardiology; Professor of Medicine; Chief, Division of Cardiology, Penn State College of Medicine, Penn State Hershey Heart and Vascualr Institute, Hershey, PA, USA

Brahmajee K. Nallamothu MD, MPH, FACC

Associate Professor of Internal Medicine, Interventional Cardiology, Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA

Andrea Natale MD, FACC, FHRS

Executive Medical Director, Texas Cardiac Arrhythmias Institute at St. David’s Medical Center, Austin, TX; Consulting Professor, Division of Cardiology, Stanford University, Palo Alto, CA; Clinical Associate Professor of Medicine, Case Western Reserve University, Cleveland, OH, USA

Pablo B. Nery MD

Assistant Professor of Medicine, University of Ottawa, Staff Cardiac Electrophysiologist, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

Oyere K. Onuma MD

Mayo Clinic College of Medicine, Rochester, MN, USA

Raj S. Padwal MD, MSc, FRCPC

Associate Professor, Division of General Internal Medicine, University of Alberta, Edmonton, Alberta, Canada

Erica D. Penny-Peterson MD

Assistant Professor of Medicine, Cardiology and Cardiac Electrophysiology, Milton S. Hershey Medical Centre, Hershey, PA, USA

Marc A. Pfeffer MD, PhD

Department of Medicine, Harvard Medical School and Brigham and Women’s Hospital, Boston, MA, USA

Andrew Pipe CM, MD

Professor, Faculty of Medicine, University of Ottawa; Chief, Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

Jeffrey L. Probstfield MD

Director, Clinical Trials Service Unit, Professor of Medicine (Cardiology), University of Washington School of Medicine, Seattle, WA, USA

Bruce M. Psaty MD, PhD

Professor, Medicine and Epidemiology, Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA

Zubin Punthakee MD

Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada

Shahbudin H. Rahimtoola MB, FRCP, MACP, MACC, DSc(Hon)

Distinguished Professor, University of Southern California, George C. Griffith Professor of Cardiology, Professor of Medicine, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA

Anis Rassi Jr MD, PhD, FACC, FACP, FAHA

Scientific Director, Anis Rassi Hospital, Goiânia, Brazil

K. Srinath Reddy MD

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India

Charanjit S. Rihal MD

Consultant, Division of Cardiovascular Diseases, Mayo Clinic Rochester; Professor of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA

Robert Roberts MD, FRCPC, MACC

President and CEO, Professor of Medicine and Director, Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

Paul J. Rocchiccioli MD

BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, UK

Dan M.L. Roden MD

Professor of Medicine and Pharmacology, Director, Oates Institute, Assistant Vice-Chancellor for Personalized Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA

Annika Rosengren MD

Professor of Medicine, Department of Medicine, Sahlgrenska University Hospital/ Ostra, Göteborg, Sweden

Scott Sakaguchi MD

Associate Professor of Medicine, Cardiac Arrhythmia Center, University of Minnesota Medical School, Minneapolis, MN, USA

Zainab Samad MD

Fellow, Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA

Pedro L. Sánchez MD, PhD

Head of Section, Department of Cardiology, Associate Professor; Hospital General Universitario Gregorio Marañón, School of Medicine, Complutense University, Madrid, Spain

Irina Savelieva MD

Department of Cardiology, Division of Cardiac and Vascular Science, St George’s University of London, London, UK

Ernesto L. Schiffrin MD, PhD, FRSC, FRCPC, FACP

Physician-in-Chief and Chair, Department of Medicine, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada

André Schmidt MD, PhD

Assistant Professor, Cardiology Division, Medical School of Ribeir ão Preto, University of São Paulo, Ribeirão Preto, Brazil

Jon-David R. Schwalm BSc, MD, FRCPC

Chief Cardiology Resident, McMaster University, Hamilton General Hospital Site, Hamilton, Ontario, Canada

Arya M. Sharma MD, PhD, FRCPC

Professor of Medicine, Chair for Obesity Management & Research, University of Alberta, Edmonton, Alberta, Canada

Ashfaq Shuaib MD, FRCPC, FAHA

Professor of Medicine and Neurology; Director, Stroke Program, University of Alberta, Edmonton, Alberta, Canada

Marcus Vinicius Simões MD

Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil

Samuel C. Siu MD, SM

Gunton Professor and Chair of Cardiology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada

Elsayed Z. Soliman MD, MSc, MS

Associate Director, Epidemiological Cardiology Research Center (EPICARE), Assistant Professor, Department of Epidemiology and Prevention, Wake Forest University School of Medicine, WinstonSalem, NC, USA

Ray W. Squires PhD

Professor of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA

Garrick C. Stewart MD

Clinical Fellow, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

Jack C.J. Sun MD, MSc

Division of Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada

Thoralf M. Sundt III MD

Consultant, Division of Cardiovascular Surgery, Professor of Surgery, Mayo Clinic, Rochester, MN, USA

Karl Swedberg MD, PhD

Head, Department of Emergency and Cardiovascular Medicine, Professor of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital/ Östra, Göteborg, Sweden

Faisal S. Syed MD

Department of Cardiology, University of Newcastle-upon-Tyne, Newcastle, UK

Koon K. Teo MB, PhD, FRCPC, FRCPI

Professor of Medicine, Division of Cardiology, Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada

Pierre Theroux CM, MD, FACC

Professor of Medicine, Montreal Heart Institute, University of Montreal, Quebec, Canada

Peter L. Thompson MD, FRACP, FACP, FACC, MBA

Clinical Professor, Cardiologist and Director of Research, Sir Charles Gairdner Hospital, Clinical Professor of Medicine and Population Health, University of Western Australia, Perth, Australia

William D. Toff MD, FESC

Department of Cardiovascular Sciences, University of Leicester, Leicester, UK

Thomas T. Tsai MD, MSc

Interventional Cardiology Fellow, Cardiovascular Center, University of Michigan Hospitals, Ann Arbor, MI, USA

Jack V. Tu MD, PhD

Institute for Clinical Evaluative Sciences, University of Toronto & Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Canada

Zoltan G. Turi MD

Professor of Medicine, Robert Wood Johnson Medical School, Director, Structural Heart Disease Program, Cooper University Hospital, Camden, NJ, USA

Ameeth Vedre MD

Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA

Rachel M. Wald MD, FRCPC

Staff Cardiologist, University Health Network and Hospital for Sick Children, Assistant Professor, Department of Pediatrics, University of Toronto, Toronto, Canada

Albert L. Waldo MD

Department of Medicine, Case Western Reserve, University School of Medicine, Division of Cardiovascular Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA

Andrew Wang MD

Associate Professor of Medicine; Director, Cardiovascular Disease Fellowship Program, Duke University Medical Center, Durham, NC, USA

Deirdre Ward MRCPI

Director, Centre for Cardiovascular Risk in Younger Persons, Institute of Cardiovascular Science, Trinity College Dublin, Dublin, Republic of Ireland

John G. Webb MD, FRCPC, FACC

McLeod Professor of Valvular Heart Disease Intervention, Director, Interventional Cardiology and Cardiac Catheterization, St. Paul’s Hospital, Vancouver, BC, USA

William S. Weintraub MD

Christiana Care Health System, Center for Heart & Vascular Health, Newark, Delaware, USA

Robert C. Welsh MD, FRCPC

Associate Professor; Director, Cardiac Catheterization and Interventional Cardiology; University of Alberta & Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada

David A. Wood MSc, FRCP, FRCPE, FFPHM, FESC

Garfield Weston Professor of Cardiovascular Medicine at the National Heart and Lung Institute, Imperial College London, UK

David A. Wood MD FRCPC

Interventional Cardiology, Director, Undergraduate Cardiovascular Medical Education, Clinical Assistant Professor, University of British Columbia, Vancouver, BC, Canada

Salim Yusuf DPhil, FRCPC, FRSC

Heart and Stroke Foundation of Ontario Research Chair, Professor of Medicine, McMaster University; Director, Population Health Research Institute, McMaster University, Hamilton Health Sciences; Vice President Research, Hamilton Health Sciences, Hamilton, Ontario, Canada

Witold Zatonski MD, PhD

Director of the Cancer Epidemiology and Prevention Division, The M. SklodowskaCurie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland

Preface to the third edition

‘I had’ said he ‘come to an entirely erroneous conclusion which shows, my dear Watson, how dangerous it always is to reason from insufficient data’.

Sir Arthur Conan Doyle

Sherlock Holmes not only sought sufficient data, he scrutinized them with critical appraisal – two necessary prerequisites for an effective evidence based strategy. And so it is that clinical decision-making has come to rely more and more on best external evidence derived from well-executed large-scale clinical trials.

This is a big book. However, it can be used to best advantage in two ways: as a reference tome to gain in-depth understanding of a wide array of cardiovascular disorders, and as a source where clinicians can find and apply the best evidence to guide their management of specific cardiovascular conditions.

In 1964 over 50% of clinical research publications were devoted to clinical physiology experiments. There were no papers on clinical trials that year. The emphasis then was less on treatment and more on exploring mechanisms of disease. This changed in the 1980s so that by 2004 more than 20% of clinical research articles contained reports from large-scale clinical trials compared to only 3% that were laboratory based. This shift in emphasis from bench -to-bedside-to-community led to a startling paradox in which irrefutable evidence for the effectiveness of certain therapies not only assisted practising clinicians and their patients but begged the scientific question – “How and why does the therapeutic intervention work? ” A clarion call for a community-to-bench paradigm.

In the preface to the second edition we stated, prophetically, that “ Evidence-based medicine is a work in progress – a rapidly changing field – which cannot rest on its laurels, but must constantly be updated as newer and more effective treatments emerge ” . Although the very nature of book publication hardly competes with the instant gratification of “ late breaking ” trials presented at meetings or on-line, nevertheless the expert contributors of this compendium have successfully provided a clear and comprehensive overview of best evidence for the diagnosis and management of most cardiovascular disorders.

As with previous editions we continue to subscribe to the dictum that clinical decision-making ought to be an amalgam of best external evidence combined with clinical expertise and awareness of patients’ needs and preferences. Although evidence-based guidelines are derived from clinical trial results, the reader should bear in mind that guidelines are disease (not patient) specific. In this context caution is urged whenever attempts are made to equate guidelines with standards of care. Not only are there multiple co-morbidities in over 60% of elderly patients but there are multiple co-medications as well. If one parses many of the studies outlined in this book one often finds that the effectiveness of a given therapy is proportional to disease severity and overall risk, whereas the harm of the intervention is often risk independent.

It is also recognized that clinical trials, irrespective of their strengths, need to be interpreted in the context of large registry databases that might reflect clinical practice on a wider scale. Trials have their strengths and limitations, as do registry studies, and both should be considered as complementary and not exclusive to each other.

This edition, like those before it, is comprised of four sections. Part I addresses some key concepts related to both evidence-based cardiology and critical appraisal. Part II is devoted to prevention and preventive strategies. Part III comprises several sections encompassing the management of specific cardiovascular disorders, and Part IV is a section on clinical applications describing how external evidence is used in individual case studies. There are several new features including major vascular complications in susceptible patients undergoing non-cardiac surgery; evidence -based cardiology as applied to employment fitness in specific occupations such as transportation and aviation; ablation therapy for atrial fibrillation; arrhythmias due to monogenic disorders; different forms of cardiomyopathy including Chagas ’ disease and adult congenital heart disease.

The editors are pleased to acknowledge the helpful guidance, advice and patience from Mary Banks, Helen Harvey and Simone Heaton of Wiley-Blackwell.

Salim YusufJohn A CairnsA John CammErnest L FallenBernard J Gersh

Classification of recommendations and levels of evidence

Classification of recommendations and levels of evidence used in Evidence -Based Cardiology are as follows:

Classification of recommendations

Class I: Evidence and/or general agreement that a given procedure or treatment is beneficial, useful and effective.

Class II: Conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment.

Class IIa: Weight of evidence/opinion is in favor of usefulness/efficacy.

Class IIb: Usefulness/efficacy is less well established by evidence/opinion.

Class III: Evidence and/or general agreement that a given procedure or treatment is not useful/effective and in some cases may be harmful.

Levels of evidence

Level A: Well-conducted, large and reliable RCTs (one or more) or their overview with clear results.

Level B: RCTs (one or more) or their overview with significant limitations.

Level C:

1) High quality and persuasive cohort studies, case control studies or case series.

2) Lower quality evidence from non-randomized studies including opinions of experts.

These classes of recommendations are identical to those used by the ACC/AHA/ESC in their Guidelines documents, and the levels of evidence are very similar. Comprehensive approaches are used, which incorporate many different types of evidence (e.g. RCTs, non -RCTs, epidemiologic studies and laboratory data), and examine the architecture of the information for consistency, coherence and clarity. Classes of recommendation and levels of evidence appear in blue type either within the text (e.g. Class I, Level A) or within a table in the chapter. The system is applicable only to preventive or therapeutic interventions. It is not applicable to many other types of data such as descriptive, genetic or physiologic.

List of abbreviations

Abbreviations commonly used in this book

AADsantiarrhythmic drugsABIAnkle Brachial IndexACCAmerican College of CardiologyACDabsolute claudication distanceACEangiotensin-converting enzymeACSacute coronary syndromeADAadenine deaminaseADMAasymmetric dimethylargininAFatrial fibrillationAHAAmerican Heart AssociationAISacute ischemic strokeALIAcute limb ischemiaAMIacute myocardial infarctionAMRantibody-mediated rejection; acute mitral regurgitationARaortic regurgitationARBangiotensin receptor blockersARFacute rheumatic feverARRabsolute risk reductionARVCarrhythmogenic right ventricular cardiomyopathyARVDarrhythmogenic right ventricular dysplasiaASaortic stenosisASAacetylsalicylic acidASDatrial septal defectASMRage-standardized mortality ratesATPadenosine triphosphateAVAaortic valve areaAVBatrioventricular blockAVRaortic valve replacementAVSDatrioventricular septal defectAVVatrioventricular valveBAVbicuspid aortic valveBNPbrain natriuretic peptideBUNblood urea nitrogenCABGcoronary artery bypass graftCADcoronary artery diseaseCAVcardiac allograft vasculopathyCBFcerebral/coronary blood flowCCBcalcium channel blockercccChagas’ cardiomyopathyCCMRchronic compensated mitral regurgitationCDMRchronic decompensated mitral regurgitationCETPcholesteryl ester transfer proteinCHDcoronary heart diseaseCHFcongestive heart failureCKcreatine kinaseCKDchronic kidney diseaseCLIcritical limb ischemiaCMRcardiac magnetic resonanceCMVcytomegalovirusCOPDchronic obstructive pulmonary diseaseCPVTcatecholaminergic polymorphic ventricular tachycardiaCrCreatinineCRPC-reactive proteinCSScarotid sinus syndromeCTAcomputed tomographic angiographyCTEPHchronic thromboembolic pulmonary hypertensionCTIcavotricuspid isthmusCTPAcomputed tomographic pulmonary angiographyCVDcardiovascular diseaseCVRFcardiovascular risk factorsDADdelayed afterdepolarizationsDALYsdisability-adjusted life-yearsDCMdilated cardiomyopathyDBPdiastolic blood pressureDSAdigital subtraction angiographyEADearly afterdepolarizationsEBVEpstein-Barr virusECMVencephalomyocarditis virusEFejection fractionEKGelectrocardiogramEMBendomyocardial biopsyEPSelectrophysiologic testingESCEuropean Society of CardiologyESRerythrocyte sedimentation rateFISHfluorescence in situ hybridizationGASgroup A streptococcalGFRglomerular filtration rateGSDglycogen storage diseaseHAARThighly active antiretroviral therapyHCMhypertrophic cardiomyopathyHCthaematocritHDLhigh-density lipoproteinHFSAHeart Failure Society of AmericaHIChigh-income countriesHITheparin-induced thrombocytopeniaHIVhuman immunodeficiency virusHRQoLhealth-related quality of lifeIARTintra-atrial re-entrant tachycardiaICDimplantable cardioverter-defibrillator; initial claudication distanceICHintracerebral hemorrhageIEinfective endocarditisIFGimpaired fasting glucoseIGTimpaired glucose toleranceILRimplantable loop recorderIMHintramural hematomaINRinternational normalized ratioISHLTInternational Society for Heart and Lung TransplantationIVintravenousIVUSintravascular ultrasoundLCSDleft cardiac sympathetic denervationLDHlactate dehydrogenaseLDLlow-density lipoproteinLMIClow- and middle-income countriesLMWHlow molecular weight heparinLoBline of blockLRlikelihood ratioLSCAleft subclavian arteryLSDlysosomal storage disordersLVleft ventricle/ventricularLVEFleft ventricular ejection fractionLVHleft ventricular hypertrophyLVOTLV outflow tractLVOTOleft ventricular outflow tract obstructionsLVSDleft ventricular systolic dysfunctionMACEmajor adverse cardiovascular eventsMCOTmobile cardiac outpatient telemetryMDTDmaximum daily therapeutic doseMETSmetabolic equivalentsMImyocardial infarctionMSmitral stenosisMTTMyocarditis Treatment TrialMUFAmonounsaturated fatty acidsMVRmitral valve replacementNCDnon-communicable diseasesNNTnumber needed to treatNRTnicotine replacement therapyNSAIDsnon-steroidal anti-inflammatory drugsNSVTnon-sustained ventricular tachycardiaNVAFnon-valvular atrial fibrillationOACoral anticoagulantsOLATorganized left atrial tachyarrhythmiaORodds ratioPADperipheral arterial diseasePAHpulmonary arterial hypertensionPAPpulmonary artery pressuresPARspopulation-attributable risksPAUpenetrating atherosclerotic ulcerPBAVpercutaneous balloon aortic valvuloplastyPBMVpercutaneous balloon mitral valvuloplastyPCApercutaneous angioplastyPCIpercutaneous coronary interventionPDApatent ductus arteriosusPDGFplatelet-derived growth factorPFOpatent foramen ovalePOTSpostural orthostatic tachycardia syndromePPAplexogenic pulmonary arteriopathyPRpulmonary regurgitationPSpulmonary stenosisPSVTparoxysmal supraventricular tachycardiaPTLDpost-transplant lymphoproliferative disorderPUFApolyunsaturated fatty acidsPVpulmonary valvePVARparavalvular aortic regurgitationPVEprosthetic valve endocarditisPVIpulmonary vein isolationPVRpulmonary vascular resistancePVSpulmonary valve stenosisPVTprosthetic valve thrombosisQALYsquality-adjusted life-yearsQoLquality of lifeRASrenin-angiotensin systemRCTrandomized controlled/clinical trialRFradiofrequencyRHDrheumatic heart diseaseRRrelative riskRRRrelative risk reductionRVright ventricle/ventricularSAECGsignal-averaged ECGSAHsubarachnoid hemorrhageSAMsystolic anterior motionSASsubvalvar aortic stenosisSBPsystolic blood pressureSFAsaturated fatty acidsSIDSsudden infant death syndromeSNDsinus node dysfunctionSNPssingle nucleotide polymorphismsSTEMIST segment elevated myocardial infarctionSUNDSsudden unexplained nocturnal death syndromeSVASsupravalvar aortic stenosisTAVRtranscatheter aortic valve replacementTCPCtotal cavopulmonary connectionTEthromboembolicTEEtransesophageal echocardiographyTGAtransposition of the great arteriesTIAtransient ischemic attackTLOCtransient loss of consciousnessTOFtetralogy of FallotTRtricuspid regurgitationTSHthyroid-stimulating hormoneTTEtransthoracic echocardiographyTVtricuspid valveTWAT-wave alternansUFHunfractionated heparinVFventricular fibrillationVKAsvitamin K antagonistsVSDventricular septal defectVTventricular tachycardiaVTEvenous thromboembolismVUIvenous ultrasound imaging

I General concepts and critical appraisal

Salim Yusuf, Editor

1

Evidence-based decision making: patient–physician interface

Philip J Devereaux,1 Marc Pfeffer2 and Salim Yusuf1

Introduction

In 1836 Elisha Bartlett, the editor of the American Journal of Medical Sciences, heralded a study as “one of the most important medical works of the present century, marking the start of a new era in science.”1 What evoked such praise and suggested a paradigm shift was Dr Pierre Louis’ systematic collection and numerical presentation of data on blood letting. Louis adopted a Baconian approach of collecting vast amounts of data on a large number of patients (by the standards of the early 1800s), which allowed him to systematically evaluate the efficacy of blood letting. Louis argued that large numbers of patients and enumeration were necessary to equalize differences between treatment groups since “by so doing, the errors (which are inevitable), being the same in two groups of patients subjected to different treatment, mutually compensate each other, and they may be disregarded without sensibly affecting the exactness of the results.”2 Louis subsequently went on to state: “a therapeutic agent cannot be employed with any discrimination or probability of success in a given case, unless its general efficacy, in analogous cases, has been previously ascertained” and thus, “without the aid of statistics nothing like real medicine is possible.”3

The prevailing concept of illness, at the time, was that the sick were contaminated, whether by some toxin or contagion, or an excess of one humor or another. This understanding of illness contained within it the idea that these states were improved by opening a vein and letting the sickness run out. Louis’ finding that blood letting hastened the death of the ill was a bombshell. George Washington had 2.4 liters of blood drained from him in the 15 hours prior to his death; he had been suffering from a fever, sore throat, and respiratory difficulties for 24 hours.4 Some have suggested that Washington was murdered.5–7

While this is a relatively recent example, the plea for comparative evaluation is mentioned as early as the Old Testament. Throughout history there have been repeated exhortations to quantify medical or health problems and to compare outcomes in patient groups managed differently, with the goal of setting state policy or assisting individual physicians.

In this chapter we will consider what evidence-based medicine is and then discuss an approach to evidence -based decision making. We will use a clinical case to highlight the components of this approach which include: clinical state and circumstances, patient preferences and actions, research evidence, and clinical expertise. At the end of the chapter we will review the application of these components of evidence-based decision making as they apply to our patient and provide a decision aid that clinicians can use in such a case. This chapter is an overview of core concepts and other chapters in this book (e.g. clinical trials and meta-analysis) provide more in-depth coverage of specific topics.

What is evidence-based medicine?

Although the foundations for evidence-based medicine were laid over several centuries, an explicit philosophy with its attendant concepts, definitions, and models has been largely developed as a formal doctrine only during the last few decades. Evidence-based medicine is about solving clinical problems. Initially, the focus of evidence-based medicine was largely on finding the best objective quantifiable research evidence relevant to the particular problem, and applying that evidence in resolving the particular issue.8 This early focus de-emphasized “intuition, unsystematic clinical experience, and pathophysiologic rationale as sufficient grounds for clinical decision making” and stressed “the examination of evidence from clinical research.”9 Subsequent versions of evidence-based decision making have emphasized that research evidence alone is rarely sufficient to make a clinical decision.10 Research evidence by itself seldom tells us what to do in individual situations, but rather it provides useful information that allows us to make more informed decisions. Clinicians must always view evidence in the context of the individual patient and then weigh the potential benefits versus the risks, costs, and inconveniences of each action. Ideally the patient’s values and preferences affect these issues10

An initial description of evidence-based medicine from an editorial in 1996 provided the following definition: “Evidence-based medicine is the conscientious and judicious use of current best evidence from clinical care research in the management of individual patients.”10 The editorial also included the caveat that the definition of evidence -based medicine will evolve as new types of information emerge and therefore will be continuously refined. The concepts of evidence-based medicine have evolved considerably and the current model is outlined in Figure 1.1.8 In the next section we use this model of evidence -based clinical decision making to help resolve a common clinical scenario.

Figure 1.1 Current model of evidence-based clinical decision making.

Approach to evidence-based clinical decision making

Clinical scenario

A family physician refers a patient who has just moved cities to live with his daughter. The physician is requesting our input on the appropriateness of antithrombotic therapy. The patient is an 80-year-old male with a history of hypertension who 10 months ago, on routine exam, was diagnosed with atrial fibrillation. The patient suffered a major gastrointestinal bleed, requiring hospitalization, urgent endoscopy, and a transfusion 1 month prior to his diagnosis of atrial fibrillation. At the time of his bleed, the patient on endoscopy was diagnosed with a duodenal ulcer and Helicobacter pylori