Dr. Joseph Kim

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KIM, J, Evans S, Smeeth L, Pocock, S. Hormone replacement therapy and acute myocardial infarction: a large observational study exploring the influence of age.International Journal of Epidemiology, 2006: 35;731-738 KIM J, Meade T and Haines A. Skinfold thickness, body mass index and fatal coronary heart disease: 30-year follow-up of the Northwick Park Heart Study.Journal of Epidemiology and Community Health, 2006: 60; 275-279

Most of these gains appeared to have been due to improvements in angina grade," said Joseph Kim, Ph.D., at the London School of Hygiene and Tropical Medicine.
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Dr. Kim said the decreasing differences between the two groups were probably due to the fact that many patients in the conservative treatment group were ultimately referred to angiography and possible intervention if their symptoms were not adequately managed by drugs alone.Thus, over time, the differences between the groups became blurred.Just over 10 percent of the patients randomized to the conservative therapy group underwent a revascularization procedure during their initial hospitalization.Within one year, revascularizations had been performed in 28 percent of the patients in the conservative therapy group compared to 57 percent of the patients in the early intervention group.

"What is remarkable is that despite this crossover of patients, we observed statistically significant improvements in health-related quality of life at 4-months follow-up and to a lesser extent at 1-year follow-up," Dr. Kim said.

The researchers wrote that these results appear to strengthen the case for early intervention.

"The public policy implications of this study are that an early intervention strategy should be recommended to reduce the occurrence of refractory angina and possibly to improve angina-related health related quality of life in patients with non-ST-segment elevation acute coronary syndrome.However, this benefit must be balanced against economic cost and clinical risk of performing an early intervention on all patients," they wrote.

Dr. Kim noted that the researchers had to make some assumptions about the quality of life of patients at the beginning of the study, because they did not have baseline scores for all the measures.Also, he said there is some uncertainty about what some of the differences in the measured quality of life scores mean in the daily lives of patients.
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I would be less inclined to place such a strict interpretation on quality of life scores," Dr. Kim said.

Most of these gains appeared to have been due to improvements in angina grade," said Joseph Kim, PhD, at the London School of Hygiene and Tropical Medicine.
...
Dr. Kim said the decreasing differences between the two groups were probably due to the fact that many patients in the conservative treatment group were ultimately referred to angiography and possible intervention if their symptoms were not adequately managed by drugs alone.Thus, over time, the differences between the groups became blurred.Just over 10 percent of the patients randomized to the conservative therapy group underwent a revascularization procedure during their initial hospitalization.Within one year, revascularizations had been performed in 28 percent of the patients in the conservative therapy group compared to 57 percent of the patients in the early intervention group.

"What is remarkable is that despite this crossover of patients, we observed statistically significant improvements in health-related quality of life at 4-months follow-up and to a lesser extent at 1-year follow-up," Dr. Kim said.

The researchers said that these results appear to strengthen the case for early intervention.

"The public policy implications of this study are that an early intervention strategy should be recommended to reduce the occurrence of refractory angina and possibly to improve angina-related health related quality of life in patients with non-ST-segment elevation acute coronary syndrome.However, this benefit must be balanced against economic cost and clinical risk of performing an early intervention on all patients," they noted.

Dr. Kim noted that the researchers had to make some assumptions about the quality of life of patients at the beginning of the study, because they did not have baseline scores for all the measures.Also, he said there is some uncertainty about what some of the differences in the measured quality of life scores mean in the daily lives of patients.
...
I would be less inclined to place such a strict interpretation on quality of life scores," Dr. Kim said.

Dr Joseph Kim

Dr Joseph Kim, Email: joseph.kim@lshtm.ac.uk

Most of these gains appeared to have been due to improvements in angina grade," said Joseph Kim, Ph.D., at the London School of Hygiene and Tropical Medicine.
...
Dr. Kim said the decreasing differences between the two groups were probably due to the fact that many patients in the conservative treatment group were ultimately referred to angiography and possible intervention if their symptoms were not adequately managed by drugs alone.Thus, over time, the differences between the groups became blurred.Just over 10 percent of the patients randomized to the conservative therapy group underwent a revascularization procedure during their initial hospitalization.Within one year, revascularizations had been performed in 28 percent of the patients in the conservative therapy group compared to 57 percent of the patients in the early intervention group.

"What is remarkable is that despite this crossover of patients, we observed statistically significant improvements in health-related quality of life at 4-months follow-up and to a lesser extent at 1-year follow-up," Dr. Kim said.

The researchers wrote that these results appear to strengthen the case for early intervention.

"The public policy implications of this study are that an early intervention strategy should be recommended to reduce the occurrence of refractory angina and possibly to improve angina-related health related quality of life in patients with non-ST-segment elevation acute coronary syndrome.However, this benefit must be balanced against economic cost and clinical risk of performing an early intervention on all patients," they wrote.

Dr. Kim noted that the researchers had to make some assumptions about the quality of life of patients at the beginning of the study, because they did not have baseline scores for all the measures.Also, he said there is some uncertainty about what some of the differences in the measured quality of life scores mean in the daily lives of patients.
...
I would be less inclined to place such a strict interpretation on quality of life scores," Dr. Kim said.

Joseph Kim Honorary Lecturer