sations into a picture. Drop from 'picture' the connotations of 'picturesque' and think in terms of visual enquiry and description. Thus, Oezanne's pictures are as much description and enquiry as mathematical pictures; symbolic logic pictures and pictures in physics models. Cezanne studied objects and tried to grasp and present the relationships between them. Paul Klee argued that the artist's task was to 'render visible'.

With the WHO in China

[Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction].

Background -Studies have examined the use of evidence-based therapies for coronary artery disease(CAD) in the short term and at hospital discharge, but few have evaluated long-term use. Methods and Results -Using the Duke Databank for Cardiovascular Disease for the years 1995 to 2002, we determined the annual prevalence and consistency of serf-reported use of aspirin, β-blockers, lipid-lowering agents, and their combinations in all CAD patients and of angiotensin-converting enzyme inhibitors(ACEIs) in those with and without heart failure. Logistic-regression models identified characteristics associated with consistent use(reported on ≥2 consecutive follow-up surveys and then through death,withdrawal, or study end), and Cox proportional-hazards models explored the association of consistent use with mortality. Use of all agents and combinations thereof increased yearly. In 2002, 83%reported aspirin use; 61%, β-blocker use; 63%, lipid-lowering therapy use; 54%, aspirin and β-blocker use; and 39%, use of all 3. Consistent use was as follows: For aspirin, 71%; β-blockers, 46%; lipid-lowering therapy, 44%; aspirin and β-blockers, 36%; and all 3, 21%. Among patients without heart failure, 39%reported ACEI use in 2002; consistent use was 20%. Among heart failure patients, ACEI use was 51%in 2002 and consistent use, 39%. Except for ACEIs among patients without heart failure, consistent use was associated with lower adjusted mortality: Aspirin hazard ratio(HR), 0.58 and 95%confidence interval(CI), 0.54 to 0.62; β-blockers, HR, 0.63 and 95%CI, 0.59 to 0.67; lipid-lowering therapy, HR, 0.52 and 95%CI, 0.42 to 0.65; all 3, HR, 0.67 and 95%CI, 0.59 to 0.77; aspirin and β-blockers, HR, 0.61 and 95%CI, 0.57 to 0.65; and ACEIs among heart failure patients, HR, 0.75 and 95%CI, 0.67 to 0.84. Conclusions -Use of evidence-based therapies for CAD has improved but remains suboptimal. Although improved discharge prescription of these agents is needed, considerable attention must also be focused on understanding and improving long-term adherence.

Long-term adherence to evidence-based secondary prevention therapies in coronary artery disease

Gender disparities in ST-segment elevation myocardial infarction (STEMI) outcomes continue to be reported worldwide; however, the magnitude of this gap remains unknown. To evaluate gender-based discrepancies in clinical outcomes and identify the primary driving factors a global meta-analysis was performed. Studies were selected if they included all comers with STEMI, reported gender specific patient characteristics, treatments, and outcomes, according to the registered PROSPERO protocol: CRD42020161469. A total of 56 studies (705,098 patients, 31% females) were included. Females were older, had more comorbidities and received less antiplatelet therapy and primary percutaneous coronary intervention (PCI). Females experienced significantly longer delays to first medical contact (mean difference 42.5 min) and door-to-balloon time (mean difference 4.9 min). In-hospital, females had increased rates of mortality (odds ratio [OR] 1.91, 95% confidence interval [CI] 1.84 to 1.99, p <0.00001), repeat myocardial infarction (MI) (OR 1.25, 95% CI 1.00 to 1.56, p=0.05), stroke (OR 1.67, 95% CI 1.27 to 2.20, p <0.001), and major bleeding (OR 1.82, 95% CI 1.56 to 2.12, p <0.00001) compared with males. Older age at presentation was the primary driver of excess mortality in females, although other factors including lower rates of primary PCI and aspirin usage, and longer door-to-balloon times contributed. In contrast, excess rates of repeat MI and stroke in females appeared to be driven, at least in part, by lower use of primary PCI and P2Y12 inhibitors, respectively. In conclusion, despite improvements in STEMI care, women continue to have in-hospital rates of mortality, repeat MI, stroke, and major bleeding up to 2-fold higher than men. Gender disparities in in-hospital outcomes can largely be explained by age differences at presentation but comorbidities, delays to care and suboptimal treatment experienced by women may contribute to the gender gap.

Meta-Analysis of Gender Disparities in In-hospital Care and Outcomes in Patients with ST-Segment Elevation Myocardial Infarction

Objective This study aims to understand the current ST elevated myocardial infarction (STEMI) treatment process in Guangdong Province and explore patient-level and system-level barriers associated with delay in STEMI treatment, so as to provide recommendations for improvement Methods This is a qualitative study Data were collected using semistructured, face-to-face individual interviews from April 2018 to January 2019 Participants included patients with STEMI, cardiologists and nurses from hospitals, emergency department doctors, primary healthcare providers, local health governors, and coordinators at the emergency medical system (EMS) An inductive thematic analysis was adopted to generate overarching themes and subthemes for potential causes of STEMI treatment delay The WHO framework for people-centred integrated health services was used to frame recommendations for improving the health system Results Thirty-two participants were interviewed Patient-level barriers included poor knowledge in recognising STEMI symptoms and not calling EMS when symptoms occurred Limited capacity of health professionals in hospitals below the tertiary level and lack of coordination between hospitals of different levels were identified as the main system-level barriers Five recommendations were provided: (1) enhance public health education; (2) strengthen primary healthcare workforce; (3) increase EMS capacity; (4) establish an integrated care model; and (5) harness government’s responsibilities Conclusions Barriers associated with delay in STEMI treatment were identified at both patient and system levels The results of this study provide a useful evidence base for future intervention development to improve the quality of STEMI treatment and patient outcomes in China and other countries in a similar situation

https://heart.bmj.com/content/heartjnl/106/19/1477.full.pdf

Patient-level and system-level barriers associated with treatment delays for ST elevation myocardial infarction in China

Cardiovascular diseases in China: The blue book myocardial infarction

Current status of hypertension in China cardiovascular diseases in China - The blue book

On behalf of the expert group of Expert Consensus on Intensive Statin Therapy for Patients with Acute Coronary Syndrome

Expert consensus on intensive statin therapy for patients with acute coronary syndrome

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Cardiovascular diseases in China: The blue book myocardial infarction

Current status of hypertension in China cardiovascular diseases in China - The blue book

Expert consensus on intensive statin therapy for patients with acute coronary syndrome