International Circulation: In a previous interview， you said one of the things you were most proud of during your time as ACC President was the development of the registry system at ACC. Are registries a new innovation in the West? For how long have they been utilized?
　　《国际循环》：在此前的采访中，您曾说您在作ACC主席期间最引以为豪的事情之一是ACC注册系统的开发。注册中心在西方是一个新的创新吗？对此已经利用了多久？
　　Prof Brindis: I would say they are in their awkward adolescence. Again， I am very proud of the National Cardiovascular Data Registry. It has been in existence for around twelve years. We have six registries that are up and running. We have over fifteen million patient records which represent an investment from the American College of Cardiology on a yearly basis of around 25million dollars. We have seventy employees at Heart House in Washington who are actively involved in running the registries. The registries were initially formed to help hospitals and physicians understand practice patterns for care and to improve care. What we now realize is that the registries are very important in terms of post-market surveillance， in terms of regulatory assessment and also in informing our clinical practice guidelines taskforce and writing groups how to actually fill some of the evidence gaps that randomized clinical trials leave us with in terms of understanding best practice care.
　　Brindis教授：我会说他们还处于其尴尬的青春期。我再次为全国心血管数据注册中心感到非常自豪。它已经存在了大约十二年。我们有6个运行的注册处。我们有超过1500万患者的病例记录，这意味着来自美国心脏病学学会每年约2500万美元的年度基础投资。我们在华盛顿Heart House有70名员工在积极参与注册中心的运营。注册中心最初是成立用于帮助医院和医生了解医疗的实践模式并改善医疗。我们现在认识到的是，注册中心在上市后监测方面、在监管评估方面、还有在理解最佳医疗实践方面在告知我们临床实践指南特别工作组和编写组如何确实填补一些随机临床试验留给我们的证据空白上都是非常重要的。
　　International Circulation: Your presentation today was entitled， “Appropriateness in Coronary Revascularization”. Can you explain to us the approaches used in evaluating whether coronary revascularization is appropriate for a patient and which approach would be most suitable?
　　《国际循环》：您今天的演讲题目为“冠状动脉血运重建的适当性”。您能给我们解释一下在评估患者是否适合冠状动脉血运重建上所用的方法，以及哪种方法最适合？
　　Prof Brindis: This is a hot button issue particularly in the United States. I will firstly give you some background to the issue. Interventional cardiologists are actually under attack in the United States. The reason for that is that 43% of all Medicare expenses are cardiovascular. We have limited funds. The Medicare budget is being decreased dramatically and we are running out of money. When the government and payers look at areas of opportunity， they are looking directly down the barrel at cardiologists because of all the expenses we incur. Of course most of the things that we do that are evidence-based are important but there are opportunities with some of our technologies that can be utilized where they are not necessarily of value. We must， as professionals， be stewards of the healthcare dollar. We shouldn’t use things wastefully when they don’t have benefit.
　　As a professional society we appreciated that it was our role， if we want to actually assess whether it is or is not appropriate to do things. We created a document called the Appropriate Use Criteria which is based on our clinical trials and our evidence-based clinical practice guidelines， and through that we were able to determine the 180 most common scenarios when it is appropriate， inappropriate or uncertain to do coronary revascularization. The way that we have done this is to look into the mind of an interventional cardiologist， how they think and how they approach a patient. Basically there are five domains of how they think and whether a patient should be revascularized. First， how the patient presents – whether they have any symptoms or whether they are in the setting of an acute heart attack. Second， whether they are on any medication – are they on none or everything in the kitchen cabinet. Third， what are the findings on their non-invasive studies – do the nuclear stress tests show no evidence or low risk of ischemia or high risk of ischemia? And then there is their clinical burden of disease – on coronary angiography， do they have left main or triple vessel disease and so on. By looking at all those different factors， one can determine whether it is appropriate， inappropriate or uncertain to do coronary revascularization.
　　Brindis教授：这是一个热点问题，尤其是在美国。对这个问题，我首先介绍一下背景。介入心脏病学在美国实际上是受到攻击的。其原因是全部医疗费用的43％是心血管。我们的资金有限。医疗保险预算正在急剧降低，我们的钱要用完了。当政府和付款者寻找有机会的地方时，由于我们所引起的所有费用，他们直接不赞成心脏病医生这一处。当然大部分我们所做的循证的事情是重要的，但也有机会是一些我们可以利用的技术不一定有价值。作为专业人士，我们必须做医疗保健美元的管家。我们不应该在他们没有益处时浪费地使用东西。作为一个专业的社会，我们充分意识到这是我们的职责，如果我们想实际评估要做的事情是否恰当。我们创建了一个称为适当使用标准的文件，是以我们的临床试验和我们的循证临床实践指南为基础，且通过这个我们能够确定180个最常见的情景中何时进行冠状动脉血运重建是适当的、不适当的或者不确定的。我们这样做的方法是调查介入心脏病专家的想法，他们怎么认为以及他们是如何处理患者的。大体上，他们怎么认为以及患者是否应接受血运重建有五个领域。首先，患者的表现如何—— 他们是否有任何症状，或者他们是否处于急性心脏病发作状态。其次，他们是否在接受任何药物治疗——他们在接受药柜中的一切药物还是一个也没有？第三，非侵入性研究有何结果—— 核压力测试显示没有缺血证据或缺血风险低或缺血风险高吗？然后有冠状动脉造影上其疾病的临床负担，他们有做主干或三支血管病变吗？等等。通过考察所有这些不同的因素，我们可以确定进行冠状动脉血运重建是否适当，不适当或不确定。

上一页  [1]  [2]  [3]  下一页