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Evidence-based cardiovascular medicine: Why another journal?
Evidence-based Cardiovascular Medicine: Why anotherjournal?
The last few decades have seen a remarkable expansion in cardiovascular research, resulting in a better understanding of the distribution and determinants of cardiovascular disease as well as the basic biologic mechanisms. No longer are we content to extrapolate based on logic from experimental data. but quite correctly, we require proof that a specific risk factor causes a disease or that a treatment is effective from well-designed human studies. The field of cardiology has been a pioneer in innovations in the design and conduct of large studies exploring causation of disease (case-control and cohort studies), determining prognosis (databases and registries), evaluating treatments (large trials) and synthesizing the information by meta-analyis. Such studies have increased in number and size; their quality has improved and their impact in changing clinical practice is growing. How does the busy clinician keep up with this explosion of information? How is the clinician to judge which studies are valid? How is the clinician to know how a particular study fits into the context of other relevant information? The Journal of Evidence-based Cardiovascular Medicine is specifically designed to bring together the key evidence relevant to the causation, prevention, diagnosis and treatment of cardiovascular diseases by: 1. Identifying the most clinically relevant articles published every 3 months by systematically searching 23 internal medicine, cardiology and cardiovascular surgery journals regularly. All articles that meet specific basic methodologic criteria are identified every week by editorial staff and presented to the editors.
APRIL 1997
2. Selection of articles for review by the editors is based on validity of methods and on clinical relevance. (For example, treatments should generally be evaluated utilizing randomized trials). Occasionally, when a topic is highly relevant but well-designed randomazed trials are not available, we may choose to feature an article that may be based on non-randomized data if these studies are carefully done. Each article is then summarized utilizing a structured abstract of about 450 words to ensure that the important message of the article is captured. 3. We obtain brief, informative commentaries by experts for each article. These commentaries feature the strengths and weaknesses of each study and interpret the study in the context of other relevant information. Each commentator is encouraged to provide a 'bottom line'. The editors firmly believe that 'evidence' can be derived from many different kinds of studies. Such studies include epidemiology, randomized trials, registries, pathophysiology and animal experiments. The most persuasive evidence has to be not only methodologically correct, but should also provide a coherent architecture of complementary, and clinically-relevant information. Such 'knowledge' derived from this matrix of information has to be transferred to clinical practice at the bedside or into preventive programs in the community (clinical wisdom). The need to train clinicians on 'how' to transfer the knowledge derived from good studies to the bedside requires an art and judgment that is at the heart of good evidence-based medicine. We will, therefore, feature in each issue an
interview with a well-known clinicianscientist on a set of questions related to a common clinical dilemma (Evidencebased medicine at the bedside). In particular, we will focus on how 'evidence-based' approaches can be utilized when the evidence is not yet complete (evidence-based medicine in the 'gray zones'). A second feature will be brief, focused essays on major prevention questions. A third feature will be the 'dissection' of high profile articles. Such articles are generally chosen if they provide not only useful medical information, but if they could also serve as a forum to discuss pertinent methodologic issues. This series, titled 'Under the Microscope', should be informative, educational and hopefully entertaining. A final feature of the Journal will be a summary of one or two very important studies reported at each major cardiology meeting (e.g. American Heart Association, European Society of Cardiology, or American College of Cardiology). Only studies that are of very high quality and likely to have a significant impact will be covered in this section. A group of expert clinical scientists drawn from all over the world participate actively as Associate Editors or serve as members of the Editorial Board. They provide guidance regarding the policy directions and editorial style of the Journal and contribute a large proportion of the commentaries and featured articles. The style and the content will undoubtedly evolve over time. We welcome comments from readers and these will be taken seriously and will help the Journal to improve. After all, it is your Journal and should meet your needs. The editors and the publishers will strive to provide you with clinically relevant and methodologically high-quality information in a timely, informative and succinct style.
Salim Yusuf MB BS DPhil FRCPC Editor Allan D. Kitching BSc MSc MD FRCPC Deputy Editor
EVIDENCE-BASED CARDIOVASCULAR MEDICINE
1
The last few decades have seen a remarkable expansion in cardiovascular research, resulting in a better understanding of the distribution and determinants of cardiovascular disease as well as the basic biologic mechanisms. No longer are we content to extrapolate based on logic from experimental data. but quite correctly, we require proof that a specific risk factor causes a disease or that a treatment is effective from well-designed human studies. The field of cardiology has been a pioneer in innovations in the design and conduct of large studies exploring causation of disease (case-control and cohort studies), determining prognosis (databases and registries), evaluating treatments (large trials) and synthesizing the information by meta-analyis. Such studies have increased in number and size; their quality has improved and their impact in changing clinical practice is growing. How does the busy clinician keep up with this explosion of information? How is the clinician to judge which studies are valid? How is the clinician to know how a particular study fits into the context of other relevant information? The Journal of Evidence-based Cardiovascular Medicine is specifically designed to bring together the key evidence relevant to the causation, prevention, diagnosis and treatment of cardiovascular diseases by: 1. Identifying the most clinically relevant articles published every 3 months by systematically searching 23 internal medicine, cardiology and cardiovascular surgery journals regularly. All articles that meet specific basic methodologic criteria are identified every week by editorial staff and presented to the editors.
APRIL 1997
2. Selection of articles for review by the editors is based on validity of methods and on clinical relevance. (For example, treatments should generally be evaluated utilizing randomized trials). Occasionally, when a topic is highly relevant but well-designed randomazed trials are not available, we may choose to feature an article that may be based on non-randomized data if these studies are carefully done. Each article is then summarized utilizing a structured abstract of about 450 words to ensure that the important message of the article is captured. 3. We obtain brief, informative commentaries by experts for each article. These commentaries feature the strengths and weaknesses of each study and interpret the study in the context of other relevant information. Each commentator is encouraged to provide a 'bottom line'. The editors firmly believe that 'evidence' can be derived from many different kinds of studies. Such studies include epidemiology, randomized trials, registries, pathophysiology and animal experiments. The most persuasive evidence has to be not only methodologically correct, but should also provide a coherent architecture of complementary, and clinically-relevant information. Such 'knowledge' derived from this matrix of information has to be transferred to clinical practice at the bedside or into preventive programs in the community (clinical wisdom). The need to train clinicians on 'how' to transfer the knowledge derived from good studies to the bedside requires an art and judgment that is at the heart of good evidence-based medicine. We will, therefore, feature in each issue an
interview with a well-known clinicianscientist on a set of questions related to a common clinical dilemma (Evidencebased medicine at the bedside). In particular, we will focus on how 'evidence-based' approaches can be utilized when the evidence is not yet complete (evidence-based medicine in the 'gray zones'). A second feature will be brief, focused essays on major prevention questions. A third feature will be the 'dissection' of high profile articles. Such articles are generally chosen if they provide not only useful medical information, but if they could also serve as a forum to discuss pertinent methodologic issues. This series, titled 'Under the Microscope', should be informative, educational and hopefully entertaining. A final feature of the Journal will be a summary of one or two very important studies reported at each major cardiology meeting (e.g. American Heart Association, European Society of Cardiology, or American College of Cardiology). Only studies that are of very high quality and likely to have a significant impact will be covered in this section. A group of expert clinical scientists drawn from all over the world participate actively as Associate Editors or serve as members of the Editorial Board. They provide guidance regarding the policy directions and editorial style of the Journal and contribute a large proportion of the commentaries and featured articles. The style and the content will undoubtedly evolve over time. We welcome comments from readers and these will be taken seriously and will help the Journal to improve. After all, it is your Journal and should meet your needs. The editors and the publishers will strive to provide you with clinically relevant and methodologically high-quality information in a timely, informative and succinct style.
Salim Yusuf MB BS DPhil FRCPC Editor Allan D. Kitching BSc MSc MD FRCPC Deputy Editor
EVIDENCE-BASED CARDIOVASCULAR MEDICINE
1