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Endpoints and trials: a matter of life and death. Classification of death in patients under antiarrhythmic treatment

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Practice and Progress in Cardiac Pacing and Electrophysiology

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 183))

Abstract

Sometimes, a distinction is made between the art and science of medicine, but these two concepts are closely related. The clinician must act as rationally as possible. A scientific approach to clinical medicine only helps to disclose the importance of the human factor. Medical ethics also belong to the art of medicine. Since the clinician must always aim at doing what is best for the patient and for the community he serves, all clinical decisions have an ethical component [1]. The science of trials has added another dimension to academic research: the ultimate evidence that in clinical medicine, blindness is more helpful than observational skills. A double blind randomized placebo controlled approach has proven to be the only method, able to overcome honorable intellectual biases. It can not be denied that trials are attractive for three more reasons: (1) commercial interests; (2) in large hospitals, it is convenient to enter the patient in a therapeutic trial, as the trial takes over all therapeutic responsibility; (3) better patient follow-up.

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References

  1. Wulff HR, Lennard-Jones JE. Rational Diagnosis and Treatment. Oxford: Blackwell Scientific Publications 1981: 4.

    Google Scholar 

  2. Feinstein AR. An additional basic science for clinical medicine: II. The limitations of randomized trials. Ann Intern Med 1983; 99: 544–50.

    PubMed  CAS  Google Scholar 

  3. Epstein AE. AVID necessity. PACE 1993; 16: 1773–5.

    PubMed  CAS  Google Scholar 

  4. The CAST Investigators. Effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med 1989; 321: 406–12.

    Article  Google Scholar 

  5. Echt DS et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo—The Cardiac Arrhythmia Suppression Trial. N Engl J Med 1991; 324: 781–8.

    Article  PubMed  CAS  Google Scholar 

  6. The Cardiac Arrhythmia suppression Trial II Investigators. Effect of the antiarrhythmic agent moricizine on survival after myocardial infarction. N Engl J Med 1992; 327: 227–33.

    Article  Google Scholar 

  7. Greene HL, Richardson DW, Barker AH et al. Classification of deaths after myocardial infarction as arrhythmic or nonarrhythmic (The Cardiac Arrhythmia Pilot Study). Am J Cardiol 1989; 63: 1–6.

    Article  PubMed  CAS  Google Scholar 

  8. The CASCADE Investigators. Cardiac arrest in Seattle: Conventional versus amiodarone drug evaluation (The CASCADE Study). Am J Cardiol 1991; 67: 578–84.

    Article  Google Scholar 

  9. Ector H, Rogers R, Rubens A et al. Classification of death in patients under antiarrhythmic treatment. PACE 1993; 16: 2250–4.

    PubMed  CAS  Google Scholar 

  10. The Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. Boston: Little, Brown and Company 1973: 286.

    Google Scholar 

  11. Lown B, Wolf M. Approaches to sudden death from coronary heart disease. Circulation 1971; 44: 130–42.

    PubMed  CAS  Google Scholar 

  12. Lown B. Sudden cardiac death - 1978. Circulation 1979; 60: 1593–9.

    PubMed  CAS  Google Scholar 

  13. Lown B. Sudden cardiac death — 1978. Circulation 1979; 60: 1593–9.

    PubMed  CAS  Google Scholar 

  14. Kim SG, Fogoros RN, Furman S et al. Standardized reporting ICD patient outcome: The report of a North American Society of Pacing and Electrophysiology policy conference, February 9–10, 1993. PACE 1993; 16: 1358–62.

    PubMed  CAS  Google Scholar 

  15. Rogers R, Ector H, Rubens A, Timmermans C, Heidbüchel H, De Geest H. Classification of death in patients under antiarrhythmic treatment. In Aubert AE, Ector H, Stroobandt R (eds): Cardiac pacing and electrophysiology. A bridge to the 21st century. Dordrecht, The Netherlands: Kluwer Academic Publishers 1994; 41–8.

    Chapter  Google Scholar 

  16. Simon SR, Powell LH, Bartzokis TC, Hoch DH. A new system for classification of cardiac death as arrhythmic, ischemic, or due to myocardial pump failure. Am J Cardiol 1995; 76: 896–8.

    Article  PubMed  CAS  Google Scholar 

  17. Ector H. Endpoints and trials: a matter of life and death. PACE 1994; 17: 1079–81.

    PubMed  CAS  Google Scholar 

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© 1996 Kluwer Academic Publishers

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Ector, H. (1996). Endpoints and trials: a matter of life and death. Classification of death in patients under antiarrhythmic treatment. In: Oto, M.A. (eds) Practice and Progress in Cardiac Pacing and Electrophysiology. Developments in Cardiovascular Medicine, vol 183. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-0219-0_1

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  • DOI: https://doi.org/10.1007/978-94-009-0219-0_1

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-6582-5

  • Online ISBN: 978-94-009-0219-0

  • eBook Packages: Springer Book Archive

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