Journal of cardiovascular electrophysiology
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J. Cardiovasc. Electrophysiol. · Sep 2003
What is right and what is wrong about evidence-based medicine?
Practice should, as much as possible, be based on good science. Randomized clinical trials can provide the best evidence, but they have serious limitations. ⋯ Second, trials seldom can study the effects seen in different subgroups, nor can the results always be extrapolated from the restricted groups of patients recruited into trials. Finally, there is publication bias: the failure to report "negative" trials and the biased presentation of results by investigators and sponsors.
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J. Cardiovasc. Electrophysiol. · Sep 2003
Randomized Controlled Trial Clinical TrialAnalysis of implantable cardioverter defibrillator therapy in the Antiarrhythmics Versus Implantable Defibrillators (AVID) Trial.
The implantable cardioverter defibrillator (ICD) is commonly used to treat patients with documented sustained ventricular tachycardia (VT) or ventricular fibrillation (VF). Arrhythmia recurrence rates in these patients are high, but which patients will receive a therapy and the forms of arrhythmia recurrence (VT or VF) are poorly understood. ⋯ Delivery of ICD therapy in AVID patients was common, primarily due to VT. Inappropriate ICD therapy occurred frequently. Use of ICD therapy as a surrogate endpoint for death in clinical trials should be avoided.
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J. Cardiovasc. Electrophysiol. · Sep 2003
Comparative StudyIssues in subgroup analyses and meta-analyses of clinical trials.
This commentary discusses two techniques commonly used to analyze clinical trials: subgroup analysis and meta-analysis. Subgroup analysis is used to evaluate the consistency of a treatment across multiple groups, usually within a clinical trial. ⋯ Meta-analysis is a formal way of summarizing the totality of information coming from well-conducted randomized clinical trials. The use and limitations of these two techniques are discussed.
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J. Cardiovasc. Electrophysiol. · Sep 2003
ReviewAutomatic external defibrillators for prevention of out-of-hospital sudden death: effectiveness of the automatic external defibrillator.
Approaches to the prevention of sudden cardiac death (SCD) include strategies designed to attack the problem from the multiple perspectives of primary prevention of the underlying diseases, prophylactic treatment of high-risk individuals with identified diseases, and responses to cardiac arrest victims in the community. The latter strategy began with conventional fire department-based emergency rescue systems (emergency medical services [EMS]) that originated in the early 1970s. ⋯ The value of conventional EMS systems remains because of their ability to provide advanced life support as part of a dual-response system. These approaches, in conjunction with better primary and secondary prevention strategies, offer the hope of reducing the SCD burden.