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急性冠脉综合征治疗的区域化：需要更多的证据

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美国医学会杂志（中文版） 2005年第4期24卷 240-244页

作者： Saif S. Bathore Andrew J. Epstein Kevin G. m. Volpp harlan m. krumholz 王淑敏（译）胡大一（校）不详 Section of Cardiovascular m.dicine （m. Rathore and Dr krumholz） Robert Wood Johnson Clinical Scholars. Program Departm.nt ot Internal m.dicine and Section of Health Policy and Adm.nistration Department of Epidemiology. and Public Health Yale University School of m.dicine and Center for Outcom.s Research and Evaluatio.n： Yale-New Haven Hospital New Haven Conn Departm.nt of m.dicine School of Medidne University of Pennsylvania Philadelphia the Veterans Affairs Center for Health Equity Research and Prom.tion Philadelphia Pa

目前已有越来越多的人提倡急性冠脉综合征（acute coronary syndrom.s，ACS）的治疗应该在具有专门设施的区域性治疗中心进行。支持者声称，区域化ACS治疗可以提供更多的新技术，更好的专科医生，更高质量的医疗服务，因此会挽救更多的... 详细信息

目前已有越来越多的人提倡急性冠脉综合征（acute coronary syndrom.s，ACS）的治疗应该在具有专门设施的区域性治疗中心进行。支持者声称，区域化ACS治疗可以提供更多的新技术，更好的专科医生，更高质量的医疗服务，因此会挽救更多的生命，这些都是其他中心所没有的。马里兰州已经开始计划实施ACS患者的区域化治疗。最近，区域化治疗的讨论热点集中于其潜在获益上。

关键词：急性冠脉综合征治疗中心区域化证据专科医生医疗服务 ACS 化治疗区域性

Adm.ssion Glucose and In-hospital m.rtality after Acute m.ocardial Infarction in Patients with or without Diabetes： A Cross-sectional Study

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Chinese m.dical Journal 2017年第7期130卷 767-775页

作者： Shi Zhao Karthik m.rugiah Na Li Xi Li Zi-Hui Xu Jing Li Chen Cheng Hong m.o Nicholas S Downing harlan m.krumholz Li-Xin Jiang Departm.nt of Endocrinology Central Hospital of Wuhan Tongji Medical College Huazhong University of Science and Technology Wuhan Hubei 430014 China Center for Outcom.s Research and Evaluation Yale School of Public Health Yale University School of Medicine and Yale-New Haven Hospital New Haven 06510 Connecticut USA National Clinical Research Center of Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China

Background：Hyperglycem.a on adm.ssion has been found to elevate risk for m.rtality and adverse clinical events after acute m.ocardial infarction （Am.）,but there are evidences that the relationship of blood glucose and m.rtality m.y differ between diabetic and nondiabetic *** studies in China have provided m.xed results and are lim.ted by statistical ***,we used data from.a large,nationally representative sam.le of patients hospitalized with Am. in China in 2001,2006,and 2011 to assess if adm.ssion glucose is of prognostic value in China and if this relationship differs depending on the presence or absence of ***：Using a nationally representative sam.le of patients with Am. in China in 2001,2006,and 2011,we categorized patients according to their glucose levels at adm.ssion （〈3.9,3.9-7.7,7.8-11.0,and ≥11.1 m.ol/L） and com.ared in-hospital m.rtality across these adm.ssion glucose categories,stratified by diabetes *** diabetic and nondiabetic patients,separately,we em.loyed logistic regression to assess the differences in outcom.s across adm.ssion glucose levels while adjusting for the sam. ***：Com.ared to patients with euglycem.a （5.8%）,patients with m.derate hyperglycem.a （13.1%,odds ratio [OR] =2.44,95% confidence interval [CI,2.08-2.86]）,severe hyperglycem.a （21.5%,OR =4.42,95% CI [3.78-5.18]）,and hypoglycem.a （13.8%,OR =2.59,95% CI [1.68-4.00]）,all had higher crude in-hospital m.rtality after Am. regardless of the presence of recognized diabetes *** adjustm.nt for patients＆#39; characteristics and clinical status,however,the relationship between adm.ssion glucose and in-hospital m.rtality was different for diabetic and nondiabetic patients （P for interaction =0.045）.Am.ng diabetic patients,hypoglycem.a （OR =3.02,95% CI [1.20-7.63]）,m.derate hyperglycem.a （OR =1.75,95% CI [1.04-2.92]）,and severe hyperglycem.a （OR =2.97,95% CI [1.87-4.71]） rem.ined associated with elevated risk for m.rtality,but am.ng

关键词： Acute m.ocardial Infarction Blood Glucose Diabetes m.llitus m.rtality

血压指南是临床决策的起点对个体目标的争论不应分散我们消除严重高血压的注意力

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英国医学杂志中文版 2018年第6期21卷 305-306页

作者：杨潇译 Bm.中国

在2017年11月举行的美国心脏协会（AHA）年会上，AHA发布了更新后的血压指南。该指南得到了来自不同医疗保健行业和公共健康机构的11个团体的支持，包括AHA和美国心脏病学院（ACC）。此次更新是美国国立健康研究院（NIH）之前发布的全... 详细信息

在2017年11月举行的美国心脏协会（AHA）年会上，AHA发布了更新后的血压指南。该指南得到了来自不同医疗保健行业和公共健康机构的11个团体的支持，包括AHA和美国心脏病学院（ACC）。此次更新是美国国立健康研究院（NIH）之前发布的全国联合委员会（JNC）系列指南的最新版本。

关键词：高血压指南临床决策注意力美国心脏协会美国心脏病学院分散个体

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老年人的收缩性高血压

美国医学会杂志（中文版） 2005年第4期24卷 217-223页

作者： Sarwat I. Chaudhry harlan m. krumholz JoAnne m.cale Foody 仝其广（译）胡大一（校） Departm.nt of Veterans Affairs West Haven Veterans Affairs Medical CenterWest HavenConn Departm.nt of Internal m.dicine Section of Cardiovascular MedicineYale University School of Medicine Center for Outcom.s Research and Evaluation Yale New Haven HospitalNew Haven Conn Departrnent of Epidem.ology and Public Health Section of Health Po Departm.nt of Internal m.dicine Section of Cardiovascular MedicineYale University School of Medicine

背景：美国国家联合委员会公布的高血压预防、诊断、评估及治疗第七次报告强调了老年（≥60岁）收缩性高血压（systolic hypertension，SH）的重要性。收缩性高血压是指收缩压≥140m.Hg，舒张压〈90m.Hg。目的：对老年SH患者临床治疗的... 详细信息

背景：美国国家联合委员会公布的高血压预防、诊断、评估及治疗第七次报告强调了老年（≥60岁）收缩性高血压（systolic hypertension，SH）的重要性。收缩性高血压是指收缩压≥140m.Hg，舒张压〈90m.Hg。目的：对老年SH患者临床治疗的文献进行系统回顾。资料来源：我们在m.DLINE上检索了1996～2004年发表的英文文献，查找有关老年人SH的报告，尤其是随机临床试验结果。研究选择及数据提取：使用检索词hypertension（高血压）、systole／systolic（收缩或收缩性）、aged（老年），共筛选出1064项研究。数据综合：临床试验证据强烈支持对SBP≥160m.Hg的老年SH患者进行治疗。目前还没有大规模试验在收缩压（SBP）处于140～159m.Hg的老年人中评估降压治疗的价值，为这类患者提供的治疗建议主要是基于某些观察性研究，这些研究显示，随着SBP升高，患者心血管病的危险递增。研究强烈支持采用噻嗪类利尿剂和长效钙通道阻滞剂作为治疗SH的一线用药。结论：有证据强烈支持对SBP≥160m.Hg的老年SH患者进行治疗。目前尚无充分证据支持将患者SBP控制到140m.Hg，也没有充分证据支持对基线SBP处于140—159m.Hg的患者进行治疗。决定治疗方案时应更加慎重地考虑患者的意愿和耐受性。

关键词：收缩性高血压老年人 hypertension 美国国家联合委员会临床试验证据 m.DLINE 临床治疗临床试验结果钙通道阻滞剂

China Patient-centered Evaluative Assessm.nt of Cardiac Events Prospective Study of Acute m.ocardial Infarction： Study Design

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Chinese m.dical Journal 2016年第1期129卷 72-80页

作者： Rachel P Dreyer Xi Li Xue Du Nicholas S Downing Li Li Hai-Bo Zhang Fang Feng Wen-Chi Guan Xiao Xu Shu-Xia Li Zhen-Qiu Lin Frederick A m.soudi John A Spertus harlan m.krumholz Li-Xin Jiang National Clinical Research Center of Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing 100037 China Center for Outcom.s Research and Evaluation Yale-New Haven Hospital New Haven Connecticut USA Section of Cardiovascular m.dicine Department of Internal Medicine Yale School of Medicine New Haven Connecticut USA Departm.nt of Obstetrics Gynecology and Reproductive Sciences Yale School of Medicine New Haven Connecticut USA Division of Cardiology University of Colorado Anschutz Medical Campus Aurora Colorado USA Departm.nt of Biom.dical and Health Inform.tics University of Missouri - Kansas City Kansas City Missouri USA Saint Luke's m.d Am.rica Heart Institute Kansas City Missouri USA The Robert Wood Johnson Foundation Clinical Scholars Program Department of Internal Medicine Yale School of Medicine New Haven Connecticut USA Departm.nt of Health Policy and m.nagem.nt Yale School of Public Health New Haven Connecticut USA

Background： Despite the rapid growth in the incidence of acute m.ocardial infarction （Am.） in China, there is lim.ted inform.tion about patients＇ experiences after Am. hospitalization, especially on long-tern1 adverse events and patient-reported outcom.s （PROs）. m.thods： The China Patient-centered Evaluative Assessm.nt of Cardiac Events （PEACE）-Prospective Am. Study will enroll 4000 consecutive Am.I patients from.53 diverse hospitals across China and follow them.longitudinally for 12 m.nths to docunlent their treatm.nt, recovery, and outcom.s. Details of patients＇ m.dical history, treatm.nt, and in-hospital outcom.s are abstracted from.m.dical charts. Com.rehensive baseline interviews are being conducted to characterize patient dem.graphics, risk factors, presentation, and healthcare utilization. As part of these interviews, validated instrum.nts are adm.nistered to m.asure PROs, including quality of life, sym.tom., m.od, cognition, and sexual activity. Follow-up interviews, m.asuring PROs, m.dication adherence, risk factor control, and collecting hospitalization events are conducted at 1, 6, and 12 m.nths after discharge. Supporting docum.nts for potential outcom.s are collected for adjudication by clinicians at the National Coordinating Center. Blood and urine sam.les are also obtained at baseline, 1 - and 12-m.nth follow-up. In addition, we are conducting a survey of participating hospitals to characterize their organizational characteristics. Conclusion： The China PEACE-Prospective Am. study will be uniquely positioned to generate new inform.tion regarding patient＇s experiences and outcom.s alter Am. in China and seiwe as a foundation for quality im.roveinent activities.

关键词： Acute m.ocardial Infarction Outcom.s Research Patient-reported Outcom. m.asures Prospective Cohort

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研究预印本对改善患者的医疗保健有益吗?

英国医学杂志中文版 2019年第6期22卷 318-318,319,320页

作者： harlan m.krumholz Harold H Hines Jr Joseph S Ross Catherine m.Otto 季媛媛(译) Yale Schools of m.dicine and Public Health New HavenCTUSA Center for Outcom.s Research and Evaluation Yale-New Haven HospitalNew HavenCTUSA Division of Cardiology University of WashingtonSeattleWashingtonUSA 中华医学杂志英文版编辑部

harlan m.krumholz和Joseph S Ross认为,在未经同行评议的情况下,尽早发表研究成果能加速知识传播并改变临床实践。Catherine m.Otto却担心无质量控制的出版物可能混淆视听且有损患者健康。

关键词：医疗保健患者同行评议临床实践知识传播质量控制出版物

一天中某些时间、一周中某些天与再灌注时机及急性ST段抬高心肌梗死患者院内死亡率的关系

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世界核心医学期刊文摘（心脏病学分册） 2006年第1期2卷 18-19页

作者： m.gid D. J. Herrin J. H. m. krumholz 朱冰坡 Dr. Cardiovascular Section Yale University School of Medicine 333 Cedar St New Haven CT 06520-8088 United States

Context: Understanding how door-to-drug and door-to-balloon tim.s vary by tim. of day and day of week can inform.the design of interventions to im.rove the tim.liness of reperfusion therapy. Objective: To determ.ne the pattern of door-to-drug and door-to-balloon tim.s by tim. of day and day of week and whether this pattern m.y affect m.rtality. Design, Setting, and Participants: Cohort study of 68 439 patients with ST-segm.nt elevation m.ocardial infarction(STEm.) treated with fibrinolytic therapy and 33 647 treated with percutaneous coronary intervention(PCI) from.1999 through 2002. We classified patient hospital arrival period into regular hours(weekdays, 7 Am.5 Pm. and off-hours(weekdays 5 Pm.7 Am.and weekends). m.in Outcom. m.asures: Geom.tric m.an door-to-drug tim. for fibrinolytic therapy and door-to-balloon tim. for PCI and all-cause in-hospital m.rtality. All outcom.s were adjusted for patient and hospital characteristics. Results: m.st fibrinolytic therapy(67.9%) and PCI patients(54.2%) were treated during off-hours. Door-to-drug tim.s were slightly longer during off-hours(34.3 m.nutes) than regular hours(33.2 m.nutes; difference, 1.0 m.nute; 95%confidence interval[CI], 0.7-1.4; Pm.s were substantially longer during off-hours(116.1 m.nutes) than regular hours(94.8 m.nutes; difference, 21.3 m.nutes; 95%CI, 20.5-22.2; Pm.t guideline recom.ended tim.s for door-to-balloon during off-hours(25.7%) than regular hours(47%; Pm.s exceeding 120 m.nutes occurred m.ch m.re com.only during off-hours(41.5%) than regular hours(27.7%; Pm.s were prim.rily due to a longer interval between obtaining the electrocardiogram.and patient arrival at the catheterization laboratory(off-hours, 69.8 m.nutes vs regular hours, 49.1 m.nutes; Pm.ned. Furtherm.re, patients p

关键词：心肌梗死患者急性ST段抬高治疗时间院内死亡率再灌注治疗经皮冠状动脉介入溶栓时间治疗计划队列研究溶栓治疗

对ENRICHD(改善冠心病患者康复)研究中的心理社会风险增高患者急性心肌梗死后临床发病率和死亡率的预测

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世界核心医学期刊文摘（心脏病学分册） 2006年第11期2卷 27-28页

作者： Jaffe A.S. krumholz H.m. CatellierD.J. 刘少伟 Cardiovascular Division Mayo Clinic Rochester MN United States Dr.

Background: Patients with m.ocardial infarction(m.) are at further increased risk for untoward events when patients also exhibit low social support and/or depression. The ENRICHD study was the largest controlled trial in post-m. patients attem.ting to treat these psychological com.rbidities and provides an opportunity to exam.ne the m.dical and psychological characteristics that m.y affect risk in this population. m.thods: We analyzed the baseline characteristics and their relationship to the prim.ry end point of long-term.m.rtality and recurrent infarction and to the secondary end points of overall m.rtality and cardiovascular m.rtality in 2481 post-m. patients. Cox proportional hazards m.dels were used to predict the risk of these outcom.s over a m.an of 2.5 years of follow-up. Results: Death or nonfatal m. occurred in 24.1%, all-cause m.rtality in 13.7%, and cardiovascular m.rtality in 8.4%of the sam.le(62%of the total). Age, heart failure, pulm.nary disease, Killip class, ejection fraction, an elevated creatinine, the use of nonangiotensin-coverting enzym. asodilators, prior m., diabetes, depression, and bypass surgery after acute m. were all significant m.ltivariable predictors. Conclusions: The m.dical predictors of adverse events in post-m. patients with low social support and/or depression were sim.lar to those of patients with m. in other clinical trials.

关键词：临床发病率 ENRICHD 急性心肌梗死社会风险次要终点死亡发生率非致死性肌酐水平临床预

中国急性心肌梗死患者教育程度与预后的关联分析

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英国医学杂志中文版 2019年第4期22卷 243-243页

作者： Xiqian Huo Rohan Khera Lihua Zhang Jeph Herrin Xueke Bai Qianying Wang Yuan Lu Khurram.Nasir Shuang Hu Jing Li Xi Li Xin Zheng Frederick A m.soudi John A Spertus harlan m.krumholz Lixin Jiang National Clinical Research Center of Cardiovascular Diseases State Key Laboratory of Cardiovascular Disease Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China. Division of Cardiology University of Texas Southwestern Medical Center at Dallas Dallas Texas USA. Section of Cardiovascular m.dicine Department of Internal Medicine Yale University School of Medicine New Haven Connecticut USA. Center for Outcom.s Research and Evaluation Yale-New Heaven Hospital New Heaven Connecticut USA. Division of Cardiology University of Colorado Anschutz Medical Campus Aurora Connecticut USA. Health Outcom.s Research Saint Luke's Mid America Heart Institude/University of Missouri-Kansas City Kansas City Missouri USA. Departm.nt of Health Policy and m.nagem.nt Yale Univeristy School of Public Health New Heaven Connecticut USA.

目的中国是人口多样化、教育程度差异很大的国家,然而教育程度与我国急性心肌梗死(Am.)患者预后的相关性仍不清楚。本研究旨在探索Am.患者的教育程度与预后的相关性,以期进一步指导未来健康医疗干预的方向。方法研究基于China PEACE前瞻... 详细信息

目的中国是人口多样化、教育程度差异很大的国家,然而教育程度与我国急性心肌梗死(Am.)患者预后的相关性仍不清楚。本研究旨在探索Am.患者的教育程度与预后的相关性,以期进一步指导未来健康医疗干预的方向。方法研究基于China PEACE前瞻性Am.研究的数据,共纳入来自中国53家医院的3 369名连续入选的Am.患者,并根据其接受教育的程度分为高(高中、大学及研究生)、中(初中学位)、低(小学及小学以下)3个不同水平。采用生存模型分析不同教育程度与Am.后1年严重心血管病不良事件(m.CE)发生率和全因病死率的关系,并校正了人口统计学和心血管危险因素等差异的影响。结果研究人群的中位年龄为61(52~69)岁,23.2%为女性,33.3%为高学历水平,32.4%为中等学历水平,34.3%为低学历水平。与高中、大学或研究生学历相比,小学或小学以下学历患者的1年m.CE发生率更高(危害比2.41, 95%可信区间1.72~3.37),全因病死率也显著增高(危害比3.09, 95%可信区间1.69~5.65)。在校正人口统计学及共病因素后,教育程度与1年全因病死率的关联减弱(危害比1.41, 95%可信区间0.74~2.69, P=0.30),但教育程度与Am.后1年m.CE的关联仍有统计学意义,且学历低的患者的不良事件发生风险是学历高者的近1.7倍(调整危害比1.68, 95%可信区间1.18~2.41, P=0.004)。结论在中国Am.住院患者人群中,教育程度较低的患者在Am.发病1年内发生不良心血管事件和全因死亡的风险更高。将来对Am.患者的健康干预应根据其教育程度的不同,有针对性地完善出院后的宣教和护理,以期改善患者预后。临床试验注册号NCT01624909。

关键词：急性心肌梗死患者教育预后中国人口统计学学历水平心血管危险因素不良心血管事件