Circulation. 2007;115:157
(Circulation. 2007;115:157.)
© 2007 American Heart Association, Inc.
Issue Highlights
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REGIONAL DIFFERENCES IN PROCESS OF CARE AND OUTCOMES FOR OLDER ACUTE MYOCARDIAL INFARCTION PATIENTS IN THE UNITED STATES AND ONTARIO, CANADA, by Ko et al.
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Contrasting the care of patients in different countries can
provide insights into the effect of clinical strategies and
systems on patient outcomes. Several studies have investigated
whether the more expensive care in the United States for patients
with acute myocardial infarction provides better outcomes than
those achieved in Canada, where care is less expensive. These
studies, however, have generally been limited by the use of
administrative claims data, which lack clinical detail. Investigators
from both countries have now made use of data sets derived from
extensive medical record abstractions to evaluate how the practice
and outcomes for patients in Ontario compare with various regions
of the United States. The study by Ko and colleagues reveals
striking variations in practice, along with some similarities,
and raises questions about whether the contrasting styles translate
into differences in mortality rates. See p 196 (editorial p
158).
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EFFECTS OF CARDIAC RESYNCHRONIZATION THERAPY WITH OR WITHOUT A DEFIBRILLATOR ON SURVIVAL AND HOSPITALIZATIONS IN PATIENTS WITH NEW YORK HEART ASSOCIATION CLASS IV HEART FAILURE, by Lindenfeld et al.
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Cardiac resynchronization therapy and the implantable defibrillator,
alone or in combination, for the appropriate patients, have
been proven to be a lifesaving adjunct to medical therapy in
patients with heart failure. Although the clinical benefits
of these sophisticated electrophysiological devices are unquestioned,
patient selection to optimize risk-benefit and cost effectiveness
remains a difficult challenge. In this issue of
Circulation,
Lindenfeld et al probe the Comparison of Medical Therapy, Pacing,
and Defibrillation in Heart Failure (COMPANION) study data and
show that these devices can reduce rates of death and hospitalizations
in ambulatory New York Heart Association class IV patients.
See p 204 (editorial p
161).
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SUBCLINICAL CORONARY AND AORTIC ATHEROSCLEROSIS DETECTED BY MAGNETIC RESONANCE IMAGING IN TYPE 1 DIABETES WITH AND WITHOUT DIABETIC NEPHROPATHY, by Kim et al.
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Patients with type 1 diabetes and nephropathy maintain higher
cardiovascular mortality compared with diabetic patients with
normoalbuminuria. Risk assessment in asymptomatic patients with
type 1 diabetes is less stringent than for those with type 2
diabetes, and the effect of diabetic nephropathy on atherosclerosis
in type 1 diabetes is not well described. In this cross-sectional
study of 136 asymptomatic type 1 diabetic patients with longstanding
diabetes, Kim et al use cardiovascular magnetic resonance imaging
to reveal greater coronary plaque burden and higher prevalence
of coronary artery stenoses in patients with diabetic nephropathy
compared with those with normoalbuminuria. These data suggest
that coronary atherothrombosis may play an important role in
the overall high cardiovascular mortality in patients with type
1 diabetes and nephropathy. See p
228.
Visit http://circ.ahajournals.org:
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Images in Cardiovascular Medicine
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Electrocardiogram, Echocardiography, and Magnetic Resonance
Imaging Characteristics in Uhl’s Disease. See p
e11.
Magnetic Resonance Imaging of a Posttraumatic Myocardial Infarction and Ventricular Septal Defect With a Closure Device in Place. See p e13.
Sinus of Valsalva Aneurysm With Right Ventricular Outflow Tract Obstruction: Evaluation With Doppler, Real-Time 3-Dimensional and Contrast Echocardiography. See p e16.
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Correspondence
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See p
e18.
Related Articles:
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The Cardiovascular World Is Definitely Not Flat
- P. Kaul and E.D. Peterson
Circulation 2007 115: 158-160.
[Full Text]
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Cardiac Resynchronization Therapy in New York Heart Association Class IV Heart Failure: It Is All About Selection
- W.H. Wilson Tang and Gary S. Francis
Circulation 2007 115: 161-162.
[Full Text]
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Electrocardiogram, Echocardiography, and Magnetic Resonance Imaging Characteristics in Uhl’s Disease
- Akli Otmani, Laurent Leborgne, Cédric Renard, Houssam Bakkour, Serge Quenum, Christophe Tribouilloy, and Jean-Luc Rey
Circulation 2007 115: e11-e12.
[Full Text]
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Magnetic Resonance Imaging of a Posttraumatic Myocardial Infarction and Ventricular Septal Defect With a Closure Device in Place
- Stephanie L. Jun, Nikhil K. Chanani, Phillip Moore, and Charles B. Higgins
Circulation 2007 115: e13-e15.
[Full Text]
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Sinus of Valsalva Aneurysm With Right Ventricular Outflow Tract Obstruction: Evaluation With Doppler, Real-Time 3-Dimensional and Contrast Echocardiography
- Eli V. Gelfand, Dorota Bzymek, and Michael T. Johnstone
Circulation 2007 115: e16-e17.
[Full Text]
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Letter by Ben-Dov and Bursztyn Regarding Article, "Role of Diuretics in the Prevention of Heart Failure: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial"
- Iddo Z. Ben-Dov and Michael Bursztyn
Circulation 2007 115: e18.
[Full Text]
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Subclinical Coronary and Aortic Atherosclerosis Detected by Magnetic Resonance Imaging in Type 1 Diabetes With and Without Diabetic Nephropathy
- Won Yong Kim, Anne Sofie Astrup, Matthias Stuber, Lise Tarnow, Erling Falk, René M. Botnar, Cheryl Simonsen, Lotte Pietraszek, Peter R. Hansen, Warren J. Manning, Niels T. Andersen, and Hans-Henrik Parving
Circulation 2007 115: 228-235.
[Abstract]
[Full Text]
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