Institutional differences in carotid artery duplex diagnostic criteria result in significant variability in classification of carotid artery stenoses and likely lead to disparities in care.
Identifieur interne : 002D62 ( PubMed/Corpus ); précédent : 002D61; suivant : 002D63Institutional differences in carotid artery duplex diagnostic criteria result in significant variability in classification of carotid artery stenoses and likely lead to disparities in care.
Auteurs : Edward J. Arous ; Donald T. Baril ; William P. Robinson ; Francesco A. Aiello ; Nathanael D. Hevelone ; Elias J. Arous ; Louis M. Messina ; Andres SchanzerSource :
- Circulation. Cardiovascular quality and outcomes [ 1941-7705 ] ; 2014.
English descriptors
- KwdEn :
- Aged, Aged, 80 and over, Carotid Arteries (diagnostic imaging), Carotid Stenosis (diagnosis), Carotid Stenosis (economics), Carotid Stenosis (surgery), Disease Progression, Female, Health Care Costs, Healthcare Disparities, Humans, Male, Middle Aged, Myocardial Revascularization, New England, Patient Selection, Ultrasonography, Doppler, Duplex.
- MESH :
- diagnosis : Carotid Stenosis.
- diagnostic imaging : Carotid Arteries.
- economics : Carotid Stenosis.
- surgery : Carotid Stenosis.
- Aged, Aged, 80 and over, Disease Progression, Female, Health Care Costs, Healthcare Disparities, Humans, Male, Middle Aged, Myocardial Revascularization, New England, Patient Selection, Ultrasonography, Doppler, Duplex.
Abstract
The indications for carotid revascularization are based almost exclusively on the results of carotid duplex ultrasonography. Noninvasive vascular laboratories show large variation in the diagnostic criteria used to classify degree of carotid artery stenosis. We hypothesize that variability of these diagnostic criteria causes significant variation in stenosis classification directly affecting the number of revascularizations and associated costs.
DOI: 10.1161/CIRCOUTCOMES.113.000855
PubMed: 24737405
Links to Exploration step
pubmed:24737405Le document en format XML
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Baril</name><affiliation><nlm:affiliation>From the Department of Surgery, University of Massachusetts Medical School, Worcester, MA (Edward J. Arous, W.P.R., F.A.A., Elias J. Arous, L.M.M., A.S.); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (D.T.B.); and Department of Surgery, Brigham and Women's Hospital, Boston, MA (N.D.H.).</nlm:affiliation></affiliation></author><author><name sortKey="Robinson, William P" sort="Robinson, William P" uniqKey="Robinson W" first="William P" last="Robinson">William P. Robinson</name><affiliation><nlm:affiliation>From the Department of Surgery, University of Massachusetts Medical School, Worcester, MA (Edward J. Arous, W.P.R., F.A.A., Elias J. Arous, L.M.M., A.S.); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (D.T.B.); and Department of Surgery, Brigham and Women's Hospital, Boston, MA (N.D.H.).</nlm:affiliation></affiliation></author><author><name sortKey="Aiello, Francesco A" sort="Aiello, Francesco A" uniqKey="Aiello F" first="Francesco A" last="Aiello">Francesco A. Aiello</name><affiliation><nlm:affiliation>From the Department of Surgery, University of Massachusetts Medical School, Worcester, MA (Edward J. Arous, W.P.R., F.A.A., Elias J. Arous, L.M.M., A.S.); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (D.T.B.); and Department of Surgery, Brigham and Women's Hospital, Boston, MA (N.D.H.).</nlm:affiliation></affiliation></author><author><name sortKey="Hevelone, Nathanael D" sort="Hevelone, Nathanael D" uniqKey="Hevelone N" first="Nathanael D" last="Hevelone">Nathanael D. Hevelone</name><affiliation><nlm:affiliation>From the Department of Surgery, University of Massachusetts Medical School, Worcester, MA (Edward J. Arous, W.P.R., F.A.A., Elias J. Arous, L.M.M., A.S.); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (D.T.B.); and Department of Surgery, Brigham and Women's Hospital, Boston, MA (N.D.H.).</nlm:affiliation></affiliation></author><author><name sortKey="Arous, Elias J" sort="Arous, Elias J" uniqKey="Arous E" first="Elias J" last="Arous">Elias J. Arous</name><affiliation><nlm:affiliation>From the Department of Surgery, University of Massachusetts Medical School, Worcester, MA (Edward J. Arous, W.P.R., F.A.A., Elias J. Arous, L.M.M., A.S.); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (D.T.B.); and Department of Surgery, Brigham and Women's Hospital, Boston, MA (N.D.H.).</nlm:affiliation></affiliation></author><author><name sortKey="Messina, Louis M" sort="Messina, Louis M" uniqKey="Messina L" first="Louis M" last="Messina">Louis M. Messina</name><affiliation><nlm:affiliation>From the Department of Surgery, University of Massachusetts Medical School, Worcester, MA (Edward J. Arous, W.P.R., F.A.A., Elias J. Arous, L.M.M., A.S.); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (D.T.B.); and Department of Surgery, Brigham and Women's Hospital, Boston, MA (N.D.H.).</nlm:affiliation></affiliation></author><author><name sortKey="Schanzer, Andres" sort="Schanzer, Andres" uniqKey="Schanzer A" first="Andres" last="Schanzer">Andres Schanzer</name><affiliation><nlm:affiliation>From the Department of Surgery, University of Massachusetts Medical School, Worcester, MA (Edward J. Arous, W.P.R., F.A.A., Elias J. Arous, L.M.M., A.S.); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (D.T.B.); and Department of Surgery, Brigham and Women's Hospital, Boston, MA (N.D.H.). andres.schanzer@umassmemorial.org.</nlm:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2014">2014</date><idno type="RBID">pubmed:24737405</idno><idno type="pmid">24737405</idno><idno type="doi">10.1161/CIRCOUTCOMES.113.000855</idno><idno type="wicri:Area/PubMed/Corpus">002D62</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">002D62</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Institutional differences in carotid artery duplex diagnostic criteria result in significant variability in classification of carotid artery stenoses and likely lead to disparities in care.</title><author><name sortKey="Arous, Edward J" sort="Arous, Edward J" uniqKey="Arous E" first="Edward J" last="Arous">Edward J. Arous</name><affiliation><nlm:affiliation>From the Department of Surgery, University of Massachusetts Medical School, Worcester, MA (Edward J. Arous, W.P.R., F.A.A., Elias J. Arous, L.M.M., A.S.); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (D.T.B.); and Department of Surgery, Brigham and Women's Hospital, Boston, MA (N.D.H.).</nlm:affiliation></affiliation></author><author><name sortKey="Baril, Donald T" sort="Baril, Donald T" uniqKey="Baril D" first="Donald T" last="Baril">Donald T. Baril</name><affiliation><nlm:affiliation>From the Department of Surgery, University of Massachusetts Medical School, Worcester, MA (Edward J. Arous, W.P.R., F.A.A., Elias J. Arous, L.M.M., A.S.); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (D.T.B.); and Department of Surgery, Brigham and Women's Hospital, Boston, MA (N.D.H.).</nlm:affiliation></affiliation></author><author><name sortKey="Robinson, William P" sort="Robinson, William P" uniqKey="Robinson W" first="William P" last="Robinson">William P. Robinson</name><affiliation><nlm:affiliation>From the Department of Surgery, University of Massachusetts Medical School, Worcester, MA (Edward J. Arous, W.P.R., F.A.A., Elias J. Arous, L.M.M., A.S.); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (D.T.B.); and Department of Surgery, Brigham and Women's Hospital, Boston, MA (N.D.H.).</nlm:affiliation></affiliation></author><author><name sortKey="Aiello, Francesco A" sort="Aiello, Francesco A" uniqKey="Aiello F" first="Francesco A" last="Aiello">Francesco A. Aiello</name><affiliation><nlm:affiliation>From the Department of Surgery, University of Massachusetts Medical School, Worcester, MA (Edward J. Arous, W.P.R., F.A.A., Elias J. Arous, L.M.M., A.S.); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (D.T.B.); and Department of Surgery, Brigham and Women's Hospital, Boston, MA (N.D.H.).</nlm:affiliation></affiliation></author><author><name sortKey="Hevelone, Nathanael D" sort="Hevelone, Nathanael D" uniqKey="Hevelone N" first="Nathanael D" last="Hevelone">Nathanael D. Hevelone</name><affiliation><nlm:affiliation>From the Department of Surgery, University of Massachusetts Medical School, Worcester, MA (Edward J. Arous, W.P.R., F.A.A., Elias J. Arous, L.M.M., A.S.); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (D.T.B.); and Department of Surgery, Brigham and Women's Hospital, Boston, MA (N.D.H.).</nlm:affiliation></affiliation></author><author><name sortKey="Arous, Elias J" sort="Arous, Elias J" uniqKey="Arous E" first="Elias J" last="Arous">Elias J. Arous</name><affiliation><nlm:affiliation>From the Department of Surgery, University of Massachusetts Medical School, Worcester, MA (Edward J. Arous, W.P.R., F.A.A., Elias J. Arous, L.M.M., A.S.); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (D.T.B.); and Department of Surgery, Brigham and Women's Hospital, Boston, MA (N.D.H.).</nlm:affiliation></affiliation></author><author><name sortKey="Messina, Louis M" sort="Messina, Louis M" uniqKey="Messina L" first="Louis M" last="Messina">Louis M. Messina</name><affiliation><nlm:affiliation>From the Department of Surgery, University of Massachusetts Medical School, Worcester, MA (Edward J. Arous, W.P.R., F.A.A., Elias J. Arous, L.M.M., A.S.); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (D.T.B.); and Department of Surgery, Brigham and Women's Hospital, Boston, MA (N.D.H.).</nlm:affiliation></affiliation></author><author><name sortKey="Schanzer, Andres" sort="Schanzer, Andres" uniqKey="Schanzer A" first="Andres" last="Schanzer">Andres Schanzer</name><affiliation><nlm:affiliation>From the Department of Surgery, University of Massachusetts Medical School, Worcester, MA (Edward J. Arous, W.P.R., F.A.A., Elias J. Arous, L.M.M., A.S.); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (D.T.B.); and Department of Surgery, Brigham and Women's Hospital, Boston, MA (N.D.H.). andres.schanzer@umassmemorial.org.</nlm:affiliation></affiliation></author></analytic><series><title level="j">Circulation. Cardiovascular quality and outcomes</title><idno type="eISSN">1941-7705</idno><imprint><date when="2014" type="published">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Aged, 80 and over</term><term>Carotid Arteries (diagnostic imaging)</term><term>Carotid Stenosis (diagnosis)</term><term>Carotid Stenosis (economics)</term><term>Carotid Stenosis (surgery)</term><term>Disease Progression</term><term>Female</term><term>Health Care Costs</term><term>Healthcare Disparities</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Myocardial Revascularization</term><term>New England</term><term>Patient Selection</term><term>Ultrasonography, Doppler, Duplex</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Carotid Stenosis</term></keywords><keywords scheme="MESH" qualifier="diagnostic imaging" xml:lang="en"><term>Carotid Arteries</term></keywords><keywords scheme="MESH" qualifier="economics" xml:lang="en"><term>Carotid Stenosis</term></keywords><keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Carotid Stenosis</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Aged, 80 and over</term><term>Disease Progression</term><term>Female</term><term>Health Care Costs</term><term>Healthcare Disparities</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Myocardial Revascularization</term><term>New England</term><term>Patient Selection</term><term>Ultrasonography, Doppler, Duplex</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">The indications for carotid revascularization are based almost exclusively on the results of carotid duplex ultrasonography. Noninvasive vascular laboratories show large variation in the diagnostic criteria used to classify degree of carotid artery stenosis. We hypothesize that variability of these diagnostic criteria causes significant variation in stenosis classification directly affecting the number of revascularizations and associated costs.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">24737405</PMID><DateCreated><Year>2014</Year><Month>05</Month><Day>21</Day></DateCreated><DateCompleted><Year>2015</Year><Month>04</Month><Day>16</Day></DateCompleted><DateRevised><Year>2016</Year><Month>11</Month><Day>25</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1941-7705</ISSN><JournalIssue CitedMedium="Internet"><Volume>7</Volume><Issue>3</Issue><PubDate><Year>2014</Year><Month>May</Month></PubDate></JournalIssue><Title>Circulation. Cardiovascular quality and outcomes</Title><ISOAbbreviation>Circ Cardiovasc Qual Outcomes</ISOAbbreviation></Journal><ArticleTitle>Institutional differences in carotid artery duplex diagnostic criteria result in significant variability in classification of carotid artery stenoses and likely lead to disparities in care.</ArticleTitle><Pagination><MedlinePgn>423-9</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1161/CIRCOUTCOMES.113.000855</ELocationID><Abstract><AbstractText Label="BACKGROUND" NlmCategory="BACKGROUND">The indications for carotid revascularization are based almost exclusively on the results of carotid duplex ultrasonography. Noninvasive vascular laboratories show large variation in the diagnostic criteria used to classify degree of carotid artery stenosis. We hypothesize that variability of these diagnostic criteria causes significant variation in stenosis classification directly affecting the number of revascularizations and associated costs.</AbstractText><AbstractText Label="METHODS AND RESULTS" NlmCategory="RESULTS">The diagnostic criteria to interpret carotid duplex ultrasounds were obtained from 10 New England institutions. All carotid duplex scans performed at our institution were reviewed from 2008 to 2012. Using the diagnostic criteria from each institution, the degree of stenosis that would have been reported was classified as 70% to 99% asymptomatic, 80% to 99% asymptomatic, and 50% to 99% symptomatic. We then calculated the theoretical number of carotid revascularization procedures that this cohort would be offered using each institution's diagnostic criteria and the costs of these procedures based on reimbursement rates. Among 10 614 patients who underwent 15 534 carotid duplex scans, 31 025 arteries were reviewed. Application of the 10 institutions' criteria to the patients from our institution yielded marked variation in the number classified as 70% to 99% asymptomatic (range, 186-2201), 80% to 99% asymptomatic (range, 78-426), and 50% to 99% symptomatic (range, 157-781). If revascularizations were based on these results, costs would range from $2.2 to $26 million, $0.9 to $5.0 million, and $1.9 to $9.2 million, respectively.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Differences in diagnostic criteria to interpret carotid ultrasound result in significant variation in classification of carotid artery stenosis, likely leading to differences in the number and subsequent costs of revascularizations. This theoretical model highlights the need for standardization of carotid duplex criteria.</AbstractText><CopyrightInformation>© 2014 American Heart Association, Inc.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Arous</LastName><ForeName>Edward J</ForeName><Initials>EJ</Initials><AffiliationInfo><Affiliation>From the Department of Surgery, University of Massachusetts Medical School, Worcester, MA (Edward J. Arous, W.P.R., F.A.A., Elias J. Arous, L.M.M., A.S.); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (D.T.B.); and Department of Surgery, Brigham and Women's Hospital, Boston, MA (N.D.H.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Baril</LastName><ForeName>Donald T</ForeName><Initials>DT</Initials><AffiliationInfo><Affiliation>From the Department of Surgery, University of Massachusetts Medical School, Worcester, MA (Edward J. Arous, W.P.R., F.A.A., Elias J. Arous, L.M.M., A.S.); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (D.T.B.); and Department of Surgery, Brigham and Women's Hospital, Boston, MA (N.D.H.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Robinson</LastName><ForeName>William P</ForeName><Initials>WP</Initials><AffiliationInfo><Affiliation>From the Department of Surgery, University of Massachusetts Medical School, Worcester, MA (Edward J. Arous, W.P.R., F.A.A., Elias J. Arous, L.M.M., A.S.); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (D.T.B.); and Department of Surgery, Brigham and Women's Hospital, Boston, MA (N.D.H.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Aiello</LastName><ForeName>Francesco A</ForeName><Initials>FA</Initials><AffiliationInfo><Affiliation>From the Department of Surgery, University of Massachusetts Medical School, Worcester, MA (Edward J. Arous, W.P.R., F.A.A., Elias J. Arous, L.M.M., A.S.); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (D.T.B.); and Department of Surgery, Brigham and Women's Hospital, Boston, MA (N.D.H.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hevelone</LastName><ForeName>Nathanael D</ForeName><Initials>ND</Initials><AffiliationInfo><Affiliation>From the Department of Surgery, University of Massachusetts Medical School, Worcester, MA (Edward J. Arous, W.P.R., F.A.A., Elias J. Arous, L.M.M., A.S.); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (D.T.B.); and Department of Surgery, Brigham and Women's Hospital, Boston, MA (N.D.H.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Arous</LastName><ForeName>Elias J</ForeName><Initials>EJ</Initials><AffiliationInfo><Affiliation>From the Department of Surgery, University of Massachusetts Medical School, Worcester, MA (Edward J. Arous, W.P.R., F.A.A., Elias J. Arous, L.M.M., A.S.); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (D.T.B.); and Department of Surgery, Brigham and Women's Hospital, Boston, MA (N.D.H.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Messina</LastName><ForeName>Louis M</ForeName><Initials>LM</Initials><AffiliationInfo><Affiliation>From the Department of Surgery, University of Massachusetts Medical School, Worcester, MA (Edward J. Arous, W.P.R., F.A.A., Elias J. Arous, L.M.M., A.S.); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (D.T.B.); and Department of Surgery, Brigham and Women's Hospital, Boston, MA (N.D.H.).</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Schanzer</LastName><ForeName>Andres</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>From the Department of Surgery, University of Massachusetts Medical School, Worcester, MA (Edward J. Arous, W.P.R., F.A.A., Elias J. Arous, L.M.M., A.S.); Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA (D.T.B.); and Department of Surgery, Brigham and Women's Hospital, Boston, MA (N.D.H.). andres.schanzer@umassmemorial.org.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016448">Multicenter Study</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2014</Year><Month>04</Month><Day>15</Day></ArticleDate></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>Circ Cardiovasc Qual Outcomes</MedlineTA><NlmUniqueID>101489148</NlmUniqueID><ISSNLinking>1941-7713</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000369" MajorTopicYN="N">Aged, 80 and over</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D002339" MajorTopicYN="N">Carotid Arteries</DescriptorName><QualifierName UI="Q000000981" MajorTopicYN="Y">diagnostic imaging</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016893" MajorTopicYN="N">Carotid Stenosis</DescriptorName><QualifierName UI="Q000175" MajorTopicYN="Y">diagnosis</QualifierName><QualifierName UI="Q000191" MajorTopicYN="N">economics</QualifierName><QualifierName UI="Q000601" MajorTopicYN="N">surgery</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D018450" MajorTopicYN="N">Disease Progression</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017048" MajorTopicYN="N">Health Care Costs</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D054625" MajorTopicYN="N">Healthcare Disparities</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009204" MajorTopicYN="N">Myocardial Revascularization</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009511" MajorTopicYN="N">New England</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D018579" MajorTopicYN="N">Patient Selection</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D018616" MajorTopicYN="Y">Ultrasonography, Doppler, Duplex</DescriptorName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">carotid arteries</Keyword><Keyword MajorTopicYN="N">carotid stenosis</Keyword><Keyword MajorTopicYN="N">endarterectomy, carotid</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2014</Year><Month>4</Month><Day>17</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2014</Year><Month>4</Month><Day>17</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2015</Year><Month>4</Month><Day>17</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">24737405</ArticleId><ArticleId IdType="pii">CIRCOUTCOMES.113.000855</ArticleId><ArticleId IdType="doi">10.1161/CIRCOUTCOMES.113.000855</ArticleId></ArticleIdList></PubmedData></pubmed></record>Pour manipuler ce document sous Unix (Dilib)
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