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Informed consent is a necessary element of good clinical practice. It is important that the physician or investigator assesses patients' competence and understanding, and facilitates their participation in the decision-making process, beyond just providing information. Here, Anders Ågård discusses how consent procedures should be adapted to match a patients' degree of involvement in the decision and capacity to understand, in light of how things are in the real world.
Atrial fibrillation affects millions of people worldwide and significantly increases the risk of ischemic stroke. In this month's Viewpoint, Alan Go examines the use of anticoagulant therapy, the problems faced and future therapeutic options for the prevention of stroke in patients with atrial fibrillation.
In 2004, the UK became the first country to make statins available without a prescription. Jonathan Abrams discusses the benefits and dangers of nonprescription statins, as the debate continues about whether low-dose statins should be sold over the counter in the US.
In 2004 the ACC/AHA guideline for the management of patients with STEMI was refocused and expanded. It has become the ultimate reference for managing patients with STEMI, and here Robert Giugliano and Eugene Braunwald highlight the significant changes between the 1999 and 2004 versions that will most affect practicing clinicians.
Since its inception over 30 years ago, the Fontan principle has become well established for the management of single-ventricle circulations. In this Viewpoint, Carin van Doorn and Marc de Leval discuss the procedure's selection criteria, the surgical technique and the management of the Fontan state.
The prevalence of valve disease is increasing worldwide. Given the need to reduce the occurrence of complications experienced with mechanical and tissue valve replacements, and the realization that normal heart valves perform extremely complex functions, tissue engineering of heart valves appears to be the next logical step. In this Viewpoint, Magdi Yacoub and Johanna JM Takkenberg discuss the future of tissue engineered heart valves.
Why do some patients require an altered statin dose to achieve target cholesterol levels? In this month's Viewpoint article, understanding the genetic factors involved in statin therapy, and whether they could be used to limit the variation in patient response is discussed by Daniel Chasman and Paul Ridker.
The prospect of nonsurgical replacement of cardiac valves by percutaneous valve replacement holds immense promise for both patients and clinicians. In this Viewpoint, Younes Boudjemline and Philipp Bonhoeffer discuss the achievements so far and the future this new technique has in interventional cardiology.
A shortage of donors limits the use of heart transplantation. Despite various efforts to widen selection criteria and increase availability, the collective epidemiologic impact on donor-organ shortage has been relatively small. Approaches to date and possible ways forward, including a balance between organs and mechanical assistance, are discussed.
