<International Circulation>: I guess the point is why are we seeing fewer complications and better optimal medical therapy? Are the hospitals getting better?

　　《国际循环》：我想关键问题是为何我们看到更少的并发症和更好的最佳药物治疗？是医院做得更好吗？

　　Dr Dodson:  That is an excellent question. There are many explanations. One is that looking over time at the adherence to guidelines from the 1980s to the 1990s and into the 2000s， twenty years ago， it was largely unknown what different hospitals and different providers were doing. For example， we have great evidence that beta-blockers prolong life，but when we initially looked， there were a lot of hospitals and lot of doctors who weren’t prescribing beta-blockers. Why is that? Multiple reasons， but over time there has been an increasing adherence to guidelines and great efforts to disseminate the knowledge that these therapies help. I think that the general trend is that， in terms of optimal medical therapy certainly， dissemination of knowledge and practice coming into line with what the guidelines recommend is a major factor. The question that has been raised is， is it the registry that is affecting these outcomes or are these secular trends? We do not have a way of differentiating that but the registry is a way of reporting it. In the future， whether or not we can see that sites that are more readily engaged with the registry have better improvement in outcomes over time would be very interesting.

　　Dr Dodson: 这是一个很好的问题。有许多解释，首先是观察随时间推移，从1980s到1990s再到2000s对指南的遵循程度，20年前，很大程度上还不清楚不同医院以及不同医生在做什么。例如，我们已有大量证据表明β受体阻滞剂可延长患者寿命，但是最初，有很多医院、很多医生不给患者处方β受体阻滞剂。为什么？原因是多方面的，但随着时间推移，对指南的遵循程度在提高，人们也付出了很大努力来传播有关这些治疗获益的信息。我认为最佳药物治疗信息的传播和实践中越来越多地遵循指南的总体趋势是最主要的原因。现在我们关注的问题是，是注册研究影响了这些结果，还是长期以来的趋势使然？我们没有并非区分，但注册研究是报告的一个途径。
　　<International Circulation>: Is there any way that you would improve how the registry is done if you were able to do so?

　　《国际循环》：您对如何提高注册有什么建议？
　　Dr Dodson:  I am not engaged enough with the registry and the way that it functions to really comment on that. This is the first study I have done with the registry and I think it is a great resource but I don’t know enough about its inner workings to know what its other strengths and weaknesses are.

　　Dr Dodson： 我对注册了解并不多。这是我参与的第一个研究，我认为这是很好的资源，但是我对其工作细节了解不多，所以并不了解其他的优缺点。

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