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Absolute risk reductions and numbers needed to treat can be obtained from adjusted survival models for time-to-event outcomes.

https://arctichealth.org/en/permalink/ahliterature149699
Source
J Clin Epidemiol. 2010 Jan;63(1):46-55
Publication Type
Article
Date
Jan-2010
Author
Peter C Austin
Author Affiliation
Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada. peter.austin@ices.on.ca
Source
J Clin Epidemiol. 2010 Jan;63(1):46-55
Date
Jan-2010
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Aged
Aged, 80 and over
Female
Heart Failure - drug therapy - mortality
Humans
Male
Ontario - epidemiology
Proportional Hazards Models
Research Design
Risk Reduction Behavior
Survival Analysis
Treatment Outcome
Abstract
Cox proportional hazards regression models are frequently used to determine the association between exposure and time-to-event outcomes in both randomized controlled trials and in observational cohort studies. The resultant hazard ratio is a relative measure of effect that provides limited clinical information.
A method is described for deriving absolute reductions in the risk of an event occurring within a given duration of follow-up time from a Cox regression model. The associated number needed to treat can be derived from this quantity. The method involves determining the probability of the outcome occurring within the specified duration of follow-up if each subject in the cohort was treated and if each subject was untreated, based on the covariates in the regression model. These probabilities are then averaged across the study population to determine the average probability of the occurrence of an event within a specific duration of follow-up in the population if all subjects were treated and if all subjects were untreated.
Risk differences and numbers needed to treat.
Absolute measures of treatment effect can be derived in prospective studies when Cox regression is used to adjust for possible imbalance in prognostically important baseline covariates.
PubMed ID
19595575 View in PubMed
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Accuracy of a provincial prescription database for assessing medication adherence in heart failure patients.

https://arctichealth.org/en/permalink/ahliterature158598
Source
Ann Pharmacother. 2008 Mar;42(3):361-7
Publication Type
Article
Date
Mar-2008
Author
Karen Dahri
Stephen J Shalansky
Linda Jang
Leon Jung
Andrew P Ignaszewski
Catherine Clark
Author Affiliation
CSU Pharmaceutical Sciences, Vancouver Coastal Health, Vancouver, British Columbia, Canada. Karen.Dahri@vch.ca
Source
Ann Pharmacother. 2008 Mar;42(3):361-7
Date
Mar-2008
Language
English
Publication Type
Article
Keywords
Aged
British Columbia - epidemiology
Databases, Factual - standards
Drug Monitoring - standards
Drug Prescriptions
Female
Heart Failure - drug therapy - epidemiology
Humans
Longitudinal Studies
Male
Middle Aged
Patient compliance
Prospective Studies
Reproducibility of Results
Abstract
British Columbia's central prescription database, PharmaNet, is often used for both clinical and research applications. However, PharmaNet details prescription transactions, not actual medication consumption, resulting in many potential sources of inaccuracy when the information is assumed to reflect population or individual drug utilization.
To assess the accuracy of PharmaNet for adherence assessment in patients with heart failure who are taking beta-blockers.
A 6-month prospective, longitudinal assessment of adherence to the prescribed beta-blocker regimen was carried out using both PharmaNet data and the Medication Event Monitoring System (MEMS) for each patient enrolled. The limit of agreement between the 2 adherence assessment methods was assessed using the Bland-Altman approach.
Fifteen of 58 patients initially enrolled in the study were excluded, most due to misuse of MEMS or failure to return the MEMS vial despite thorough follow-up. For the 43 patients included in the final analysis, mean +/- SD adherence was 97.8 +/- 11.8% when assessed by PharmaNet and 97.1 +/- 7.3% when MEMS was used. However, the limit of agreement, reported as the mean of the differences +/- 2SD, was 6.8 +/- 18.5%, indicating a moderate-to-high level of agreement between the 2 methods when the confidence interval is taken into consideration.
These results suggest that PharmaNet data accurately reflect medication adherence for most patients. The MEMS system proved unreliable in several cases, illustrating the difficulty of identifying a gold standard for adherence assessment.
PubMed ID
18303147 View in PubMed
Less detail

Aging and heart failure: changing demographics and implications for therapy in the elderly.

https://arctichealth.org/en/permalink/ahliterature144487
Source
Heart Fail Rev. 2010 Sep;15(5):401-5
Publication Type
Article
Date
Sep-2010
Author
Bodh I Jugdutt
Author Affiliation
Division of Cardiology, Department of Medicine and Cardiovascular Research Group, Faculty of Medicine, 2C2 Walter MacKenzie Health Sciences Centre, University of Alberta, Edmonton, AB T6G 2R7, Canada. bjugdutt@ualberta.ca
Source
Heart Fail Rev. 2010 Sep;15(5):401-5
Date
Sep-2010
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Aging - physiology
Alberta - epidemiology
Antihypertensive Agents - therapeutic use
Cardiac Pacing, Artificial
Defibrillators, Implantable
Demography
Disease Progression
Female
Heart Failure - drug therapy - epidemiology - mortality - therapy
Humans
Male
Stroke Volume
Ventricular Dysfunction, Left - epidemiology - mortality
Ventricular Function, Left
Abstract
The elderly population (age > or =65) is increasing and with it morbidity, hospitalizations, costs and mortality due to heart failure (HF). HF is a progressive disorder that is superimposed on an on-going aging process. The two broad categories of HF, HF with left ventricular (LV) systolic dysfunction or low ejection fraction (HF/low-EF) and HF with preserved ejection fraction (HF/PEF) are equally prevalent in the elderly. Trials of therapy for HF/low-EF in primarily non-elderly patients showed mortality benefit in elderly patients. In contrast, trials for HF/PEF have not shown mortality benefit in elderly or non-elderly patients. HF pharmacotherapy in the elderly is challenging and needs to be individualized and consider several aging-related changes. More research into the biology of aging and more clinical trials in elderly patients are needed to improve morbidity and mortality in elderly HF patients.
PubMed ID
20364319 View in PubMed
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Angiotensin-converting enzyme inhibitors and survival in women and men with heart failure.

https://arctichealth.org/en/permalink/ahliterature163903
Source
Eur J Heart Fail. 2007 Jun-Jul;9(6-7):594-601
Publication Type
Article
Author
Golyar Keyhan
Shun-Fu Chen
Louise Pilote
Author Affiliation
Division of Clinical Epidemiology, The Research Institute of the McGill University Health Centre, 1650 Cedar Avenue, Room L10-421, Montreal, QC, Canada H3G 1A4.
Source
Eur J Heart Fail. 2007 Jun-Jul;9(6-7):594-601
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Cause of Death
Chronic Disease
Cohort Studies
Comorbidity
Confidence Intervals
Drug Therapy, Combination
Female
Heart Failure - drug therapy - mortality
Humans
Male
Proportional Hazards Models
Quebec
Retrospective Studies
Risk Adjustment
Risk factors
Sex Factors
Survival Rate
Treatment Outcome
Abstract
Several randomized controlled trials demonstrate that angiotensin-converting enzyme (ACE) inhibitors improve survival in patients with congestive heart failure (CHF). However, whether ACE inhibitors benefit both sexes is not adequately addressed.
Our objective was to determine the effectiveness of ACE inhibitors in women with CHF.
The Quebec hospital discharge database was linked with the physician and drug claims database to identify a cohort with a discharge diagnosis of CHF between January 1998 and March 2003. In this retrospective cohort study, subjects who filled a prescription for ACE inhibitors (19,220 exposed) were compared to those who never filled such prescription (8617 non-exposed). The primary outcome was survival by exposure to ACE inhibitors.
There were 14,693 women (67% exposed) and 13,144 men (72% exposed). The 1 year mortality was 19.5% and 30% in those exposed and non-exposed, respectively. A significant survival benefit was demonstrated in both sexes exposed to ACE inhibitors [adjusted hazard ratio (95% confidence interval): women 0.80 (0.76-0.85); men 0.71 (0.67-0.75)].
ACE inhibitors improve survival in both sexes with CHF, but the protective effect appears to be greater in men. Our results support the current recommendations for the management of women with CHF.
PubMed ID
17462947 View in PubMed
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Angiotensin II receptor blockers for the treatment of heart failure: a class effect?

https://arctichealth.org/en/permalink/ahliterature164481
Source
Pharmacotherapy. 2007 Apr;27(4):526-34
Publication Type
Article
Date
Apr-2007
Author
Marie Hudson
Karin Humphries
Jack V Tu
Hassan Behlouli
Richard Sheppard
Louise Pilote
Author Affiliation
Division of Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, Quebec. marie.hudson@mcgill.ca
Source
Pharmacotherapy. 2007 Apr;27(4):526-34
Date
Apr-2007
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Angiotensin II Type 1 Receptor Blockers - therapeutic use
Antihypertensive Agents - therapeutic use
Benzimidazoles - therapeutic use
Benzoates - therapeutic use
Biphenyl Compounds - therapeutic use
British Columbia
Drug Prescriptions - statistics & numerical data
Female
Heart Failure - drug therapy - mortality
Hospital Information Systems - statistics & numerical data
Humans
Losartan - therapeutic use
Male
Ontario
Proportional Hazards Models
Quebec
Retrospective Studies
Survival Analysis
Survival Rate
Tetrazoles - therapeutic use
Treatment Outcome
Valine - analogs & derivatives - therapeutic use
Abstract
To examine the class effect of angiotensin II receptor blockers (ARBs) on mortality in patients with heart failure who were aged 65 years or older.
Retrospective population-based study.
Administrative database that stores information on hospital discharge summaries for the Canadian provinces of Quebec, Ontario, and British Columbia.
A total of 6876 patients aged 65 years or older who were discharged with a primary diagnosis of heart failure between January 1, 1998, and March 31, 2003, and who filled at least one prescription for an ARB within 90 days of discharge.
Times to all-cause death in patients receiving individual ARBs were compared. Models were adjusted for demographic, clinical, physician, and hospital characteristics; models were also adjusted for dosage categories, which were represented by time-dependent variables. The cohort of 6876 patients had a mean +/- SD age of 78 +/- 7 years, and most (62%) were women. Losartan was the most frequently prescribed ARB (61%), followed by irbesartan (14%), valsartan (13%), candesartan (10%), and telmisartan (2%). Irbesartan, valsartan, and candesartan were associated with better survival rates than losartan (adjusted hazard ratios [HRs] and 95% confidence intervals [CIs] 0.65 [0.53-0.79], 0.63 [0.51-0.79], and 0.71 [0.57-0.90], respectively). No difference was noted in mortality in patients prescribed telmisartan compared with those receiving losartan (HR 0.92 [95% CI 0.55-1.54]).
Elderly patients with heart failure who were prescribed losartan had worse survival rates compared with those prescribed other commonly used ARBs. The absence of a class effect for ARBs is consistent with data showing pharmacologic differences among the drugs.
PubMed ID
17381379 View in PubMed
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Are there long-term benefits in following stable heart failure patients in a heart failure clinic?

https://arctichealth.org/en/permalink/ahliterature153828
Source
Scand Cardiovasc J. 2009 Jun;43(3):158-62
Publication Type
Article
Date
Jun-2009
Author
Tina H Leetmaa
Henrik Villadsen
Kirsten V Mikkelsen
Flemming Davidsen
Torben Haghfelt
Lars Videbaek
Author Affiliation
Department of Cardiology, Odense University Hospital, Denmark. tina.leetmaa.@gmail.com
Source
Scand Cardiovasc J. 2009 Jun;43(3):158-62
Date
Jun-2009
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Denmark - epidemiology
Exercise Test
Female
Follow-Up Studies
Heart Failure - drug therapy - mortality - rehabilitation
Hospitalization - statistics & numerical data
Humans
Male
Middle Aged
Natriuretic Peptide, Brain - blood
Outpatient clinics, hospital - statistics & numerical data
Peptide Fragments - blood
Prospective Studies
Survival Analysis
Abstract
This study describes the long-term outcome of 163 patients with stable mild to moderate heart failure (NYHA II-III), who already were enrolled in a heart failure clinic and now were randomized to continued follow-up in the heart failure (HF) clinic or else to usual care (UC). The primary outcome was unplanned hospitalisations and death, the secondary endpoints were pharmacological therapy, NYHA class, six-minute-walking distances and NT-pro BNP level.
At the end of follow-up we found no significant differences in total number of hospitalisation (p = 0.2) or mortality (16% vs. 16%) between the two groups. Patients in the HF clinic cohort achieved a significantly better NYHA score (p
PubMed ID
19065446 View in PubMed
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Assessment of drug treatment quality in two Danish health-care centres.

https://arctichealth.org/en/permalink/ahliterature138140
Source
Dan Med Bull. 2011 Jan;58(1):A4218
Publication Type
Article
Date
Jan-2011
Author
Kajsa Edfors
Stig Ejdrup Andersen
Author Affiliation
Department of Surgical Gastroenterology, Herlev Hospital.
Source
Dan Med Bull. 2011 Jan;58(1):A4218
Date
Jan-2011
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Aged
Aged, 80 and over
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Aspirin - therapeutic use
Denmark
Diuretics - therapeutic use
Female
Heart Failure - drug therapy
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use
Male
Middle Aged
Myocardial Ischemia - drug therapy
Qualitative Research
Quality of Health Care - standards - statistics & numerical data
Spironolactone - therapeutic use
Abstract
Bridging the primary and secondary sector, health-care centres aim to reduce morbidity and prevent further hospitalization in patients with chronic heart diseases. The aim of this study was to describe the quality of drug treatment in patients with chronic heart diseases in two Copenhagen health-care centres.
Over a period of three months, 28 patients with heart failure (HF) or ischaemic heart disease (IHD) were included. The participants were interviewed and clinically examined.
The patients received an average of nine drugs, and only about one third were clinically well-treated. Among IHD patients, 74% received beta blockers and 64% angiotensin converting enzyme-inhibitors (ACE-I) as indicated. All received statins and 92% acetylsalicylic acid. Among HF patients, 67% received ACE-I, 87% beta blockers and 77% diuretics as indicated. Overall, 10%, 31% and 40% of the HF patients received smaller than recommended doses of ACE-I, beta blockers, and diuretics, respectively. In 68% of the patients, 35 potential drug interactions were identified, none of which were deemed potentially harmful.
This small descriptive study indicates that patients in health-care centres might be undertreated and receive drug therapy only partly in accordance with the guidelines. However, since we had no access to medical charts, any reasons for not treating patients with a certain drug or selecting a lower than recommended dose could not be evaluated. Nevertheless, patients may benefit from closer involvement of clinicians or GPs in the multidisciplinary teams of the health-care centres.
PubMed ID
21205564 View in PubMed
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Association between spironolactone added to beta-blockers and ACE inhibition and survival in heart failure patients with reduced ejection fraction: a propensity score-matched cohort study.

https://arctichealth.org/en/permalink/ahliterature113288
Source
Eur J Clin Pharmacol. 2013 Oct;69(10):1747-55
Publication Type
Article
Date
Oct-2013
Author
L. Frankenstein
H A Katus
M. Grundtvig
T. Hole
J. de Blois
D. Schellberg
D. Atar
C. Zugck
S. Agewall
Author Affiliation
University of Heidelberg, Heidelberg, Germany, Lutz.Frankenstein@med.uni-heidelberg.de.
Source
Eur J Clin Pharmacol. 2013 Oct;69(10):1747-55
Date
Oct-2013
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - administration & dosage - therapeutic use
Angiotensin-Converting Enzyme Inhibitors - administration & dosage - therapeutic use
Clinical Trials as Topic
Cohort Studies
Databases, Factual
Drug Therapy, Combination
Female
Heart Failure - drug therapy - mortality - physiopathology
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Norway
Propensity Score
Proportional Hazards Models
Spironolactone - administration & dosage - therapeutic use
Stroke Volume - drug effects
Treatment Outcome
Abstract
Heart failure (CHF) guidelines recommend mineralocorticoid receptor antagonists for all symptomatic patients treated with a combination of ACE inhibitors/angiotensin receptor blockers (ARBs) and beta-blockers. As opposed to both eplerenone trials, patients in RALES (spironolactone) received almost no beta-blockers. Since pharmacological properties differ between eplerenone and spironolactone, the prognostic benefit of spironolactone added to this baseline combination therapy needs clarification.
We included 4,832 CHF patients with chronic systolic dysfunction from the Norwegian Heart Failure Registry and the heart failure outpatients' clinic of the University of Heidelberg. Propensity scores for spironolactone receipt were calculated for each patient and used for matching to patients without spironolactone.
During a total follow-up of 17,869 patient-years, 881 patients (27.0 %) died in the non-spironolactone group and 445 (28.4 %) in the spironolactone group. Spironolactone was not associated with improved survival, neither in the complete sample (HR 0.82; 95 % CI 0.64-1.07; HR 1.03; 95 % CI 0.88-1.20; multivariate and propensity score adjusted respectively), nor in the propensity-matched cohort (HR 0.98; 95 % CI 0.82-1.18).
In CHF outpatients we were unable to observe an association between the use of spironolactone and improved survival when administered in addition to a combination of ACE/ARB and beta-blockers.
PubMed ID
23743778 View in PubMed
Less detail

Association between use of ß-blockers and outcomes in patients with heart failure and preserved ejection fraction.

https://arctichealth.org/en/permalink/ahliterature258634
Source
JAMA. 2014 Nov 19;312(19):2008-18
Publication Type
Article
Date
Nov-19-2014
Author
Lars H Lund
Lina Benson
Ulf Dahlström
Magnus Edner
Leif Friberg
Source
JAMA. 2014 Nov 19;312(19):2008-18
Date
Nov-19-2014
Language
English
Publication Type
Article
Keywords
Adrenergic beta-Antagonists - therapeutic use
Aged
Aged, 80 and over
Case-Control Studies
Cohort Studies
Female
Heart Failure - drug therapy - mortality
Hospitalization
Humans
Incidence
Male
Propensity Score
Sweden - epidemiology
Ventricular Function, Left
Abstract
Heart failure with preserved ejection fraction (HFPEF) may be as common and may have similar mortality as heart failure with reduced ejection fraction (HFREF). ß-Blockers reduce mortality in HFREF but are inadequately studied in HFPEF.
To test the hypothesis that ß-blockers are associated with reduced all-cause mortality in HFPEF.
Propensity score-matched cohort study using the Swedish Heart Failure Registry. Propensity scores for ß-blocker use were derived from 52 baseline clinical and socioeconomic variables.
Nationwide registry of 67 hospitals with inpatient and outpatient units and 95 outpatient primary care clinics in Sweden with patients entered into the registry between July 1, 2005, and December 30, 2012, and followed up until December 31, 2012.
From a consecutive sample of 41,976 patients, 19,083 patients with HFPEF (mean [SD] age, 76 [12] years; 46% women). Of these, 8244 were matched 2:1 based on age and propensity score for ß-blocker use, yielding 5496 treated and 2748 untreated patients with HFPEF. Also we conducted a positive-control consistency analysis involving 22,893 patients with HFREF, of whom 6081 were matched yielding 4054 treated and 2027 untreated patients.
ß-Blockers prescribed at discharge from the hospital or during an outpatient visit, analyzed 2 ways: without consideration of crossover and per-protocol analysis with censoring at crossover, if applicable.
The prespecified primary outcome was all-cause mortality and the secondary outcome was combined all-cause mortality or heart failure hospitalization.
Median follow-up in HFPEF was 755 days, overall; 709 days in the matched cohort; no patients were lost to follow-up. In the matched HFPEF cohort, 1-year survival was 80% vs 79% for treated vs untreated patients, and 5-year survival was 45% vs 42%, with 2279 (41%) vs 1244 (45%) total deaths and 177 vs 191 deaths per 1000 patient-years (hazard ratio [HR], 0.93; 95% CI, 0.86-0.996; P?=?.04). ß-Blockers were not associated with reduced combined mortality or heart failure hospitalizations: 3368 (61%) vs 1753 (64%) total for first events, with 371 vs 378 first events per 1000 patient-years (HR, 0.98; 95% CI, 0.92-1.04; P?=?.46). In the matched HFREF cohort, ß-blockers were associated with reduced mortality (HR, 0.89; 95% CI, 0.82-0.97, P=.005) and also with reduced combined mortality or heart failure hospitalization (HR, 0.89; 95% CI, 0.84-0.95; P?=?.001).
In patients with HFPEF, use of ß-blockers was associated with lower all-cause mortality but not with combined all-cause mortality or heart failure hospitalization. ß-Blockers in HFPEF should be examined in a large randomized clinical trial.
Notes
Comment In: JAMA. 2014 Nov 19;312(19):1977-825399271
PubMed ID
25399276 View in PubMed
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Association between use of renin-angiotensin system antagonists and mortality in patients with heart failure and preserved ejection fraction.

https://arctichealth.org/en/permalink/ahliterature118614
Source
JAMA. 2012 Nov 28;308(20):2108-17
Publication Type
Article
Date
Nov-28-2012
Author
Lars H Lund
Lina Benson
Ulf Dahlström
Magnus Edner
Author Affiliation
Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden. lars.lund@alumni.duke.edu
Source
JAMA. 2012 Nov 28;308(20):2108-17
Date
Nov-28-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Angiotensin Receptor Antagonists - therapeutic use
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Female
Heart Failure - drug therapy - mortality
Humans
Male
Propensity Score
Prospective Studies
Registries - statistics & numerical data
Renin-Angiotensin System - drug effects
Stroke Volume
Survival Analysis
Sweden - epidemiology
Abstract
Heart failure with preserved ejection fraction (HFPEF) may be as common and as lethal as heart failure with reduced ejection fraction (HFREF). Three randomized trials of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ie, renin-angiotensin system [RAS] antagonists) did not reach primary end points but may have had selection bias or been underpowered.
To test the hypothesis that use of RAS antagonists is associated with reduced all-cause mortality in an unselected population with HFPEF.
Prospective study using the Swedish Heart Failure Registry of 41,791 unique patients registered from 64 hospitals and 84 outpatient clinics between 2000 and 2011. Of these, 16,216 patients with HFPEF (ejection fraction =40%; mean [SD] age, 75 [11] years; 46% women) were either treated (n = 12,543) or not treated (n = 3673) with RAS antagonists. Propensity scores for RAS antagonist use were derived from 43 variables. The association between use of RAS antagonists and all-cause mortality was assessed in a cohort matched 1:1 based on age and propensity score and in the overall cohort with adjustment for propensity score as a continuous covariate. To assess consistency, separate age and propensity score-matched analyses were performed according to RAS antagonist dose in patients with HFPEF and in 20,111 patients with HFREF (ejection fraction
Notes
Comment In: JAMA. 2013 Mar 20;309(11):1107-823512046
Comment In: JAMA. 2013 Mar 20;309(11):110723512045
Comment In: Evid Based Med. 2013 Dec;18(6):226-723585078
Comment In: JAMA. 2012 Nov 28;308(20):2144-623188032
Comment In: Nat Rev Cardiol. 2013 Feb;10(2):6023247315
Comment In: Dtsch Med Wochenschr. 2013 Feb;138(7):29623520615
PubMed ID
23188027 View in PubMed
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122 records – page 1 of 13.