FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2000702198> ?p ?o ?g. }

• W2000702198 endingPage "223" @default.
• W2000702198 startingPage "221" @default.
• W2000702198 abstract "The more than 60% reduction in age-adjusted coronary artery disease mortality rates in the past 4 decades represents one of the greatest triumphs of modern medicine. The explanations for this progress are multiple, with various analyses estimating that most of the reduction is attributable to the recognition of coronary risk factors and their appropriate reduction in tens of millions of Americans (1–3). For example, between 1980 and 1990 relatively modest changes in the average serum cholesterol levels of all Americans are estimated to have explained about 33% of the decline in coronary mortality, while reductions in smoking rates and in hypertension have probably contributed another 20% (3). These interventions to reduce risk factors, based mostly on lifestyle changes and, more recently, on medications as well, may appear relatively unexciting in each individual but have huge aggregate implications. At a time when high technology tends to dominate the national consciousness, it is striking that coronary artery bypass graft surgery, percutaneous coronary revascularization, and other acute coronary treatments have been estimated to have a smaller national impact than these “low tech” preventive measures. For example, we estimated that improvements in the care of patients with acute myocardial infarction probably accounted for only about 15% of the overall decline in coronary mortality between 1980 and 1990 (3). Although relatively small changes in risk factors in hundreds of millions of Americans may be the best way to maximize public health impact, the approach to the symptomatic patient will usually incorporate high technology interventions, especially if these interventions are known to be efficacious and worthy of their cost. In this context, the report by Heidenreich and McClellan (4) in this issue of the American Journal of Medicine is especially pertinent, because it provides useful estimates of the recent impact of a variety of interventions (especially aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, thrombolysis, and primary percutaneous transluminal coronary angioplasty) that have been shown to be both efficacious and cost effective in randomized trials of patients with acute myocardial infarction. To put their analyses into perspective, they are estimating the relative contributions of specific therapies for acute myocardial infarction to the 15% or so aggregate contribution that all such therapies have made toward the overall decline in coronary mortality. Their analyses are also useful because they provide hints as to the untapped potential of these interventions to have additional impact if their use could be extended to the full spectrum of patients who should benefit from them. This extrapolation is important because a variety of studies have demonstrated that efficacious and cost-effective cardiac interventions are oftentimes underutilized (5,6) and that extending their use to the appropriate patients who are not receiving them could generate huge benefits for the American public (7). In their analysis, Heidenreich and McClellan estimate that low technology interventions—specifically aspirin, beta-blockers, and angiotensin-converting enzyme inhibitors— explained about 44% of the decline in 30-day mortality after an acute myocardial infarction. By comparison, higher technology interventions, including thrombolysis, primary angioplasty, and secondary angioplasty for patients with indications for the procedure, probably explained about another 32% of the decline. Among the high technology interventions, I have included thrombolysis, not because the intravenous administration of a medication is truly high technology but rather because the most-commonly used agents are the result of recombinant technology. The incremental effectiveness of these agents compared with streptokinase, a medication that has been available for at least two generations of physicians, is relatively small on an absolute basis but nevertheless is probably statistically and clinically significant as well as worth the cost in many patients (8,9). At this point in time, the use of thrombolysis is becoming low technology, as most hospitals have realized that the expeditious administration of this therapy to all eligible patients is the key to improving outcomes. Although further improvements in thrombolytic regimens remain a focus of active investigation and must be encouraged, the incremental benefit of these improvements is likely to be relatively small compared with the benefits Am J Med. 2001;110:221–223. From the Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California. Requests for reprints should be addressed to Lee Goldman, MD, Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, California 94143-0120." @default.
• W2000702198 created "2016-06-24" @default.
• W2000702198 creator A5077513309 @default.
• W2000702198 date "2001-02-01" @default.
• W2000702198 modified "2023-10-18" @default.
• W2000702198 title "Outcome of acute myocardial infarction: low-tech value in a high-tech era" @default.
• W2000702198 cites W1508342416 @default.
• W2000702198 cites W1510032773 @default.
• W2000702198 cites W1531021320 @default.
• W2000702198 cites W1596397105 @default.
• W2000702198 cites W1968085564 @default.
• W2000702198 cites W1973871097 @default.
• W2000702198 cites W2013128988 @default.
• W2000702198 cites W2050353421 @default.
• W2000702198 cites W2050462129 @default.
• W2000702198 cites W2079354441 @default.
• W2000702198 cites W2079520205 @default.
• W2000702198 cites W2086437366 @default.
• W2000702198 cites W2102055267 @default.
• W2000702198 cites W2170334643 @default.
• W2000702198 cites W2325142635 @default.
• W2000702198 cites W2328180803 @default.
• W2000702198 cites W2333466480 @default.
• W2000702198 cites W2341096227 @default.
• W2000702198 cites W2342319591 @default.
• W2000702198 cites W2473230841 @default.
• W2000702198 cites W2537589444 @default.
• W2000702198 cites W3148864275 @default.
• W2000702198 cites W2006291640 @default.
• W2000702198 doi "https://doi.org/10.1016/s0002-9343(00)00734-8" @default.
• W2000702198 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/11182110" @default.
• W2000702198 hasPublicationYear "2001" @default.
• W2000702198 type Work @default.
• W2000702198 sameAs 2000702198 @default.
• W2000702198 citedByCount "1" @default.
• W2000702198 crossrefType "journal-article" @default.
• W2000702198 hasAuthorship W2000702198A5077513309 @default.
• W2000702198 hasConcept C119857082 @default.
• W2000702198 hasConcept C126322002 @default.
• W2000702198 hasConcept C144237770 @default.
• W2000702198 hasConcept C148220186 @default.
• W2000702198 hasConcept C164705383 @default.
• W2000702198 hasConcept C17744445 @default.
• W2000702198 hasConcept C177713679 @default.
• W2000702198 hasConcept C191920346 @default.
• W2000702198 hasConcept C199539241 @default.
• W2000702198 hasConcept C2776291640 @default.
• W2000702198 hasConcept C33923547 @default.
• W2000702198 hasConcept C41008148 @default.
• W2000702198 hasConcept C500558357 @default.
• W2000702198 hasConcept C71924100 @default.
• W2000702198 hasConceptScore W2000702198C119857082 @default.
• W2000702198 hasConceptScore W2000702198C126322002 @default.
• W2000702198 hasConceptScore W2000702198C144237770 @default.
• W2000702198 hasConceptScore W2000702198C148220186 @default.
• W2000702198 hasConceptScore W2000702198C164705383 @default.
• W2000702198 hasConceptScore W2000702198C17744445 @default.
• W2000702198 hasConceptScore W2000702198C177713679 @default.
• W2000702198 hasConceptScore W2000702198C191920346 @default.
• W2000702198 hasConceptScore W2000702198C199539241 @default.
• W2000702198 hasConceptScore W2000702198C2776291640 @default.
• W2000702198 hasConceptScore W2000702198C33923547 @default.
• W2000702198 hasConceptScore W2000702198C41008148 @default.
• W2000702198 hasConceptScore W2000702198C500558357 @default.
• W2000702198 hasConceptScore W2000702198C71924100 @default.
• W2000702198 hasIssue "3" @default.
• W2000702198 hasLocation W20007021981 @default.
• W2000702198 hasLocation W20007021982 @default.
• W2000702198 hasOpenAccess W2000702198 @default.
• W2000702198 hasPrimaryLocation W20007021981 @default.
• W2000702198 hasRelatedWork W2049397185 @default.
• W2000702198 hasRelatedWork W2065809242 @default.
• W2000702198 hasRelatedWork W2120735623 @default.
• W2000702198 hasRelatedWork W2367140913 @default.
• W2000702198 hasRelatedWork W2377483921 @default.
• W2000702198 hasRelatedWork W2399063111 @default.
• W2000702198 hasRelatedWork W2411183214 @default.
• W2000702198 hasRelatedWork W2437485626 @default.
• W2000702198 hasRelatedWork W3141700921 @default.
• W2000702198 hasRelatedWork W4232554619 @default.
• W2000702198 hasVolume "110" @default.
• W2000702198 isParatext "false" @default.
• W2000702198 isRetracted "false" @default.
• W2000702198 magId "2000702198" @default.
• W2000702198 workType "article" @default.