|
Prognosis and Risk Assessment in Cardiovascular Disease
|
|---|
Amar S. Kapoor and Bramah N. Singh; eds. 578 pages. New York: Churchill Livingstone; 1993. $79.95.
What makes a great clinician? No one sees enough cases to be self-sufficient. Rather, we must remain scholars, reading widely and constantly, benefiting from the accumulated experiences of our colleagues, particularly when based on prospective observations of large groups of patients followed for years.
Including risk assessment and prognosis for major cardiovascular entities in a single textbook is a highly attractive concept, and the editors are to be lauded for attempting this. In some aspects, they succeed impressively; in others, they fall short.
First the strengths. Section II discusses 10 different topics on coronary disease, including prognoses of myocardial infarction and thallium testing. Most are good, although some choices are curious. For example, why include a chapter on prognosis of young people and not one on the elderly?
Section III deals with various valvular diseases; again, most chapters are strong. However, some, such as the chapter on mitral regurgitation, do not provide enough of the available information on prognosis of this disorder. Section IV, Cardiomyopathies and Pericardial Diseases, is written by experts and covers the topics well. Chapters in section V, Arrhythmias, vary in quality. Particular gems in this section are chapters on atrial fibrillation and ventricular premature beats.
The final section on miscellaneous disorders is the most confusing. Several chapters, such as the ones on primary pulmonary hypertension, aortic diseases, and peripheral vascular disease, provide good discussions but do not focus on prognosis.
Problems with organization arise. Why is the excellent chapter on coronary artery bypass grafting by Campeau located under Miscellaneous Disorders and not in conjunction with the related chapter by Blakeman and Pifarre in the Coronary Disease section? Similarly, Lund's fine chapter Valve Replacement for Aortic Stenosis is stuck in Miscellaneous Disorders when it belongs next to Selzer's discussion of the problem in the section Valve Disorders.
Perhaps most disconcerting is the obvious lack of attention in many chapters to the aims of the book. Prognosis is often completely missing after an overview of the topic is given. The editors should have been more stringent in demanding focus on risk assessment and prognosis for each topic.
Finally, a comment about section I, Risk Factors. Chapter 1 is called Risk-Benefit Analysis but really is a wide-ranging diatribe directed at the Food and Drug Administration and money-hungry doctors. Prospective controlled clinical trials are harped on as the gold standard but nowhere is the impracticality of using only this approach mentioned, nor are reasonable alternatives such as meta-analyses or clinical outcome analyses mentioned. The other sections on risk factors are not strong and again pose curious choices. For example, attention is given to diabetes but not to hypertension. This book could have begun with section II, Coronary Disease, after an expanded introduction by the editors stating their goals for this ambitious project.
This book meets a definite need and should be available in libraries. If it were revised and shortened and each chapter conformed to the goals of assessment and prognosis, it would deserve a place in every clinicians' office.
Top
Author & Article Info
Article
