Second edition expanded and updated,

edited by Hernán C. Doval and Carlos D. Tajer;

Buenos Aires: Study Group, Teaching

and Clinical Research, 2001; 523 pages,

19 figures and 118 tables. Includes CD-ROM.

ISBN 987-98388-1-5.

The second edition of this useful review of practical cardiology follows a similar approach to the first edition published three years ago. The need for a new edition is fully justified by the large number of clinical trials published each year which extend our knowledge of the extremely active field of cardiology. Some claims that were made with little supporting data at the time have been re-examined in the light of new information. Recent studies, for example, confirm developments in intracoronary devices as part of interventional therapy or in treatment of advanced phases of heart failure. The authors have kept the structure of the previous edition but adapted the text to the recommendations of evidence-based medicine, an approach taken in other recently published books on evidence-based cardiology.

Each chapter starts with a summary of clinical practice that outlines the detailed information that follows. These summaries contain the key messages and conclusions that provide practical guidance on the benefits and risks of each therapy in specific clinical situations and scenarios. Unfortunately though, the authors do not classify this practical guidance according to the robustness of the supporting studies and evidence. A clinician would find such a classification very useful because it would directly influence the diagnosis and therapy chosen for a given patient and indicate the benefit that can be expected from therapy. Tables that classify evidence and diagnostic/therapeutic recommendations have been widely used and validated in different branches of medicine. In cardiology, many scientific societies and organizations such as the US Task Force and the American Heart Association have adopted such tables in their main evidence-based guidelines for clinical practice.

After the summary of clinical practice, each chapter moves on to an introduction of the clinical condition with a description of the definition and etiology of the disease, its basic epidemiology (incidence and prevalence, prognosis) and the objectives of treatment. The chapters then quickly focus on both pharmacological and non-pharmacological treatment and surgical procedures or device placement as appropriate, with extensive reviews of available studies.

For the main trials identified and discussed in each section, the authors have gone to the effort of performing a meta-analysis which includes a cumulative estimate of the relative risk or benefit expected with confidence intervals. This laudable undertaking makes this book a very useful reference source, not only for practicing cardiologists but also for cardiologists with teaching obligations or for residents in the area of cardiology or medicine in general, as it offers specific systematic information on all possible treatments for a given cardiovascular disease.

Another interesting aspect of the authors' approach is that the benefit and potential risk of each treatment are presented. This is particularly helpful in clinical practice for choosing the best treatment because benefit and risk, the main components of any therapeutic decision, can be easily evaluated.

Each chapter also contains succinct comments on the level of knowledge provided by the studies available, lists of studies in progress in each area and unresolved issues to be considered by future studies. This thought-provoking part of the book could help stimulate scientific debate between readers and cardiologists in general.

The comprehensive and carefully compiled references in each chapter of this book are another positive feature. We should also mention coverage of other topics related to cardiovascular disease other than heart disease, such as disease of leg arteries and the carotid artery, and the multidisciplinary and integrated approach to both primary and secondary prevention of arteriosclerotic heart disease.

The first two chapters of the book present a methodical introduction to the main concepts and approaches of evidence-based medicine. They stand the reader in good stead to understand the numerous tables and figures in the book.

Finally, the book comes with an interactive CD with specific clinical cases. The reader is presented with questions and therapeutic dilemmas for self-assessment and application of theoretical knowledge. The CD also contains tools to help design trials, programs to assess expected benefits and side effects of different treatments, a critical evaluation of trials in the medical literature, and teaching programs for use in lectures, seminars or clinical sessions.

In short, this is a fine book that will be useful not only in clinical practice but also as an academic review of different topics for cardiologists who have teaching responsibilities.