Cardiothoracic ratio within the "normal" range independently predicts mortality in patients undergoing coronary angiography.

Objective: To determine whether cardiothoracic ratio (CTR), within the range conventionally considered normal, predicted prognosis in patients undergoing coronary angiography.

Design: Cohort study with a median of 7-years follow-up.

Setting: Consecutive patients undergoing coronary angiography at Barts and The London National Health Service (NHS) Trust.

Prognosis research: why is Dr. Lydgate still waiting?

Background: Understanding prognosis--the future risk of adverse outcomes among people with existing disease--plays third fiddle behind clinical research into therapeutic interventions and novel diagnostic technologies.

Methods And Results: Diseases show marked variations in a wide range of prognostic outcomes, yet these variations have seldom been the subject of systematic and sustained epidemiologic and multidisciplinary research. This is important to prioritize hypotheses for testing in intervention studies in groups, and to refine tools for prognostication in individuals.

Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies.

Aims: With negative treatment trials, the role of depression as an aetiological or prognostic factor in coronary heart disease (CHD) remains controversial. We quantified the effect of depression on CHD, assessing the extent of confounding by coronary risk factors and disease severity.

Methods And Results: Meta-analysis of cohort studies measuring depression with follow-up for fatal CHD/incident myocardial infarction (aetiological) or all-cause mortality/fatal CHD (prognostic).

Prognosis of stable angina pectoris: why we need larger population studies with higher endpoint resolution.

The prognosis of angina was described as "unhappy" by the Framingham investigators and as little different from that of 1-year survivors of acute myocardial infarction. Yet recent clinical trials now report that angina has a good prognosis with adverse outcomes reduced to "normal levels". These disparate prognostic assessments may not be incompatible, applying as they do to population cohorts (Framingham) and selected participants in clinical trials.

How effective are rapid access chest pain clinics? Prognosis of incident angina and non-cardiac chest pain in 8762 consecutive patients.

Objective: To determine whether rapid access chest pain clinics are clinically effective by comparison of coronary event rates in patients diagnosed with angina with rates in patients diagnosed with non-cardiac chest pain and the general population.

Design: Multicentre cohort study of consecutive patients with chest pain attending the rapid access chest pain clinics (RACPCs) of six hospitals in England.

Participants: 8762 patients diagnosed with either non-cardiac chest pain (n = 6396) or incident angina without prior myocardial infarction (n = 2366) at first cardiological assessment, followed up for a median of 2.

Incidence and prognostic implications of stable angina pectoris among women and men.

Context: Stable angina pectoris in women has often been considered a "soft" diagnosis, with less-severe prognostic implications than in men, but large-scale population studies are lacking.

Objective: To determine sex differences in the incidence and prognosis of stable angina in a large ambulatory population.

Design: Prospective cohort study using linked national registers.

Comparison of the relation between renal impairment, angiographic coronary artery disease, and long-term mortality in women versus men.

Mild to moderate renal impairment has recently been associated with increased cardiovascular mortality. However, gender differences in the association of mild to moderate renal impairment with the presence of angiographic coronary artery disease and long-term mortality remain unknown. We examined a prospective cohort of consecutive patients who underwent coronary angiography from the ACRE study in the Royal Hospitals Trust (London, United Kingdom) with referral from 5 contiguous health authorities.

Searching for observational studies: what does citation tracking add to PubMed? A case study in depression and coronary heart disease.

Background: PubMed is the most widely used method for searches of the medical literature, but fails to identify many relevant articles. Electronic citation tracking offers an alternative search method.

Methods: Articles investigating the role of depression in the aetiology and prognosis of coronary heart disease were sought through two methods: a) PubMed, and b) citation tracking where Science Citation Index was searched for all articles which cited ("forward citation tracking") or were cited by ("backward citation tracking") any of the articles in an index review.

Rapid-access chest pain clinics and the traditional cardiology out-patient clinic.

Background: The National Service Framework for coronary heart disease recommends rapid-access chest pain clinics (RACPCs) for cardiological assessment of new-onset chest pain within 2 weeks of referral.

Aim: To measure the extent to which an RACPC successfully substituted for an out-patient cardiology clinic (OPCC) at a general hospital, in assessing new-onset chest pain referrals.

Methods: Prospective measurement of attendance and waiting times for consecutive patients at the RACPC and OPCC, and multivariate analysis of factors associated with referral for angiography.

Systematic review of prospective cohort studies of psychosocial factors in the etiology and prognosis of coronary heart disease.

The extent to which the associations between psychosocial factors and coronary heart disease (CHD) are causal has seldom been the subject of systematic enquiry. We are updating our previous systematic review up to 2001. The objective of this study is to assess the relative strength of the epidemiological evidence for causal links between psychosocial factors and CHD incidence among healthy populations, and prognosis among CHD patients.

Depression in older people in rural China.

Background: In Western countries depression is the most common psychiatric condition in older persons and related to low socioeconomic status and low social supports. Along with social deprivation, the rural communities in China retain many Chinese traditions that involve high levels of social supports. Studying such a population might offer insights into the cause and prevention of depression that may be applicable in developing and developed countries.

Recruiting patients to medical research: double blind randomised trial of "opt-in" versus "opt-out" strategies.

Objective: To evaluate the effect of opt-in compared with opt-out recruitment strategies on response rate and selection bias.

Design: Double blind randomised controlled trial.

Setting: Two general practices in England.

Does autonomic function link social position to coronary risk? The Whitehall II study.

Background: Laboratory and clinical studies suggest that the autonomic nervous system responds to chronic behavioral and psychosocial stressors with adverse metabolic consequences and that this may explain the relation between low social position and high coronary risk. We sought to test this hypothesis in a healthy occupational cohort.

Methods And Results: This study comprised 2197 male civil servants 45 to 68 years of age in the Whitehall II study who were undergoing standardized assessments of social position (employment grade) and the psychosocial, behavioral, and metabolic risk factors for coronary disease previously found to be associated with low social position.

Working while ill as a risk factor for serious coronary events: the Whitehall II study.

Objectives: Although sick, some people take no time off work, a phenomenon called "sickness presenteeism." This study examined the association between sickness presenteeism and incidence of serious coronary events.

Methods: The analyses were based on a cohort of 5071 male British civil servants without previous myocardial infarction.

Does access to cardiac investigation and treatment contribute to social and ethnic differences in coronary heart disease? Whitehall II prospective cohort study.

Objective: To determine whether access to cardiac procedures and drugs contributes to social and ethnic differences in coronary heart disease in a population setting.

Design: Prospective study with follow up over 15 years. Civil service employment grade was used as a measure of individual socioeconomic position.

Influence of practices' ethnicity and deprivation on access to angiography: an ecological study.

Background: Coronary heart disease is more common among some ethnic minority groups (particularly people from the Indian sub-continent living in Europe and North America) and in socially deprived populations. Hospital studies in the United Kingdom (UK) suggest that these groups have less access to treatment for coronary heart disease. Studies from primary care have found reduced access to angiography for lower social class groups, but there are no studies on the ethnicity of primary care populations in relation to angiography.

Prospective validity of measuring angina severity with Canadian Cardiovascular Society class: The ACRE study.

Background: Although the prevalence of angina remains high, the importance of grading angina severity is unclear.

Objectives: To determine the extent to which angina severity is associated with angiographic findings, and the rate of revascularization, mortality and nonfatal myocardial infarction.

Methods: Prospective, population-based study with a 2.

The determinants and effect of shared care on patient outcomes and psychiatric admissions - an inner city primary care cohort study.

Objective: The aim of this study was to determine the factors associated with receipt of different levels of shared care, and the effect of shared care on patient outcomes.

Method: A total of 349 patients with severe mental illness were selected from general practice lists. Patient functioning was assessed using standardised questionnaires, and GPs completed a questionnaire about patients' shared care arrangements at baseline (response-rate 79%).

Prognosis of angina with and without a diagnosis: 11 year follow up in the Whitehall II prospective cohort study.

Objective: To investigate the prognosis of angina among people with and without diagnosis by a doctor and an abnormal cardiovascular test result.

Design: Prospective cohort study with a median follow up of 11 years.

Setting: 20 civil service departments originally located in London.

Social and psychosocial influences on inflammatory markers and vascular function in civil servants (the Whitehall II study).

Social position and psychosocial factors are associated with coronary disease, but the underlying pathophysiologic mechanisms remain unclear. In a sample of 283 nonsmokers, we found that social position was inversely associated with interleukin-6 and C-reactive protein and that participants with mild depression had impaired endothelial function.

Measuring spatial effects in time to event data: a case study using months from angiography to coronary artery bypass graft (CABG).

The application of Bayesian hierarchical models to measure spatial effects in time to event data has not been widely reported. This case study aims to estimate the effect of area of residence on waiting times to coronary artery bypass graft (CABG) and to assess the role of important individual specific covariates (age, sex and disease severity). The data involved all patients with definite coronary artery disease who were referred to one cardiothoracic unit from five contiguous health authorities covering 488 electoral wards (areas).

Effects of moderate and vigorous physical activity on heart rate variability in a British study of civil servants.

Physical inactivity and low resting heart rate variability (HRV) are associated with increased coronary heart disease incidence. In the Whitehall II study of civil servants aged 45-68 years (London, United Kingdom, 1997-1999), the strength of the association of moderate and vigorous activity with higher HRV was examined. Five-minute recordings of heart rate and HRV measures were obtained from 3328 participants.

Is retirement good or bad for mental and physical health functioning? Whitehall II longitudinal study of civil servants.

Background: To determine whether retirement at age 60 is associated with improvement or deterioration in mental and physical health, when analysed by occupational grade and gender.

Methods: Longitudinal study of civil servants aged 54 to 59 years at baseline, comparing changes in SF-36 health functioning in retired (n=392) and working (n=618) participants at follow up. Data were collected from self completed questionnaires.