Assuntos
Insuficiência Cardíaca/terapia , Adulto , Doença Crônica , Medicina Baseada em Evidências , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Humanos , Assistência Terminal , Estados Unidos , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/terapiaRESUMO
OBJECTIVE: To explore how well physicians who treat hypertension know the indications and contraindications for particular antihypertensive therapies, and how closely their opinions and practice of hypertension treatment agree with national guidelines. METHODS: We surveyed by mail a stratified random sample of 10,000 US cardiologists, internists, and general/family practitioners. This survey explored their knowledge, attitudes, and practices with respect to the treatment of hypertension. Responses were compared with national guidelines and product labeling at the time of the survey. Results were stratified by physician specialty. RESULTS: A total of 1,023 physicians, or 10.2% of the sample, responded to the survey. Only 37.3% answered all four knowledge questions correctly, including 25.7% of general/family practitioners, 38.3% of internists, and 49.5% of cardiologists (p < 0.001). In their attitudes with respect to evaluating high blood pressure and establishing treatment goals, most respondents agreed with established guidelines. However, when asked how they would treat uncomplicated, mild hypertension, only 23% limited their selection to diuretics and beta-blockers in accordance with the guidelines. Cardiologists in particular were more likely than internists or general/family practitioners to choose other drug classes, such as angiotensin-converting enzyme Inhibitors or calcium-channel blockers. CONCLUSIONS: The results of our survey suggest that national efforts to educate physicians about the increasingly complex armamentarium for hypertension, and to persuade them to base their prescribing on the results of randomized, controlled trials of primary prevention, must be continued.
Assuntos
Anti-Hipertensivos/uso terapêutico , Conhecimentos, Atitudes e Prática em Saúde , Hipertensão/tratamento farmacológico , Padrões de Prática Médica , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Masculino , Medicina , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Especialização , Inquéritos e Questionários , Estados UnidosAssuntos
Fibrilação Atrial/diagnóstico , Fibrilação Atrial/terapia , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/classificação , Fibrilação Atrial/epidemiologia , Flutter Atrial/diagnóstico , Comorbidade , Diagnóstico Diferencial , Gerenciamento Clínico , Cardioversão Elétrica , Eletrocardiografia , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Grupos Raciais , Medição de Risco , Taquicardia/diagnóstico , Tromboembolia/etiologia , Tromboembolia/prevenção & controleAssuntos
Doenças Cardiovasculares/história , Procedimentos Cirúrgicos Cardiovasculares/história , Cateterismo Cardíaco/história , Doenças Cardiovasculares/terapia , Fenômenos Fisiológicos Cardiovasculares , Desfibriladores Implantáveis/história , Insuficiência Cardíaca/história , Insuficiência Cardíaca/prevenção & controle , Insuficiência Cardíaca/terapia , História do Século XX , Humanos , Marca-Passo Artificial/históriaAssuntos
Fibrilação Atrial/terapia , Síndrome de Wolff-Parkinson-White/terapia , Algoritmos , Antiarrítmicos/farmacologia , Antiarrítmicos/uso terapêutico , Anticoagulantes/uso terapêutico , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Cateterismo Cardíaco , Ablação por Cateter , Cardioversão Elétrica , Frequência Cardíaca/efeitos dos fármacos , Hemodinâmica , Humanos , Coeficiente Internacional Normatizado , Qualidade de Vida , Medição de Risco , Tromboembolia/complicações , Tromboembolia/fisiopatologia , Varfarina/uso terapêutico , Síndrome de Wolff-Parkinson-White/diagnóstico , Síndrome de Wolff-Parkinson-White/fisiopatologiaRESUMO
The acute coronary syndrome encompasses a spectrum of conditions that include acute myocardial infarction, unstable angina pectoris, and, to some extent, sudden cardiac death. Recently, the diagnosis of myocardial infarction has been redefined by The Joint European Society of Cardiology/American College of Cardiology Committee. However, the conceptual meaning of the term myocardial infarction has not been changed. Thus, the current diagnoses of myocardial infarction as well as of unstable angina are clinical syndromes based on symptoms, electrocardiogram, and sensitive biochemical markers.
Assuntos
Doença das Coronárias/patologia , Infarto do Miocárdio/patologia , Doença Aguda , Angina Instável/patologia , Humanos , SíndromeRESUMO
The last 2 decades witnessed remarkable events in the life of academic medical centers (AMCs) in the United States. Twenty years ago, AMCs were thriving as the era of fee-for-service medicine came to a close: clinical departments were expanding, hiring new faculty members, purchasing new equipment as necessary, and funding research projects and protected research time with the abundant clinical revenues. The subsequent 20 years since that golden era came to a close witnessed teh disappearance of these expansionary trends. Departments have contracted, protected research time and start-up funds have declined precipitously, and many faculty members are infected with a sense of malaise and fear for the future.