<International Circulation>: The AHA has maintained a close cooperation with China. Can you talk about the main focus of the AHA/GWICC joint forum?

　　Prof. Jessup: We have been a proud partner with China at the Great Wall symposium for a number of years. This year our focus is on taking the science that is the basis of our guidelines and translating them into action. How do we control hypertension? What can we do about heart failure? It is about taking the step first of forming the guidelines and then translating them into action for clinicians.

　　《国际循环》：一直以来AHA保持着与中国的密切合作。本届长城会的AHA@ GW-ICC联合论坛将重点关注哪些内容？

　　Jessup教授：我们已经连续几年在长城会上与中国同道设立联合研讨会。今年，联合论坛主要关注的是临床指南的科学基础及其向转化应用问题。我们应如何控制高血压？我们应如何治疗心力衰竭？联合论坛将首先介绍指南的循证依据，然后再关注临床医生如何将指南应用至临床实践中。

　　<International Circulation>: Are there different programs through which you are doing that， for instance， research-based versus translational research versus case-based studies?

　　Prof. Jessup:  Two of our joint sessions at this year’s congress are all based on basic science. They are talking about different aspects of research in the basic science field. Our Council on Basic Cardiovascular Sciences (BCVS) has a strong relationship with the basic scientists here in China， so they work together to form two different joint symposia.

　　《国际循环》：是否就循证研究、转化研究或病例研究设立了不同的日程？

　　Jessup教授：AHA心血管基础科学（BCVS）委员会与中国一直进行着密切的合作，双方携手共同设立了两个联合研讨会。今年联合论坛的两个部分都是关于基础科学的，主要探讨的是基础科学领域不同方面的研究。AHA心血管基础科学（BCVS）委员会与中国一直进行着密切的合作，双方携手共同设立了两个联合研讨会。

　　<International Circulation>: The AHA/ACC Guidelines for the Management of Heart Failure were updated this year. They propose the concept of GDMT. Can you explain this to our Chinese audience?

　　Prof. Jessup:  The concept of GDMT is guideline-derived medical therapy. It is a shorthand way of talking about all the evidence we have on heart failure. There is a considerable amount of evidence based on clinical trials that make up the foundation of how we treat a heart failure patient. Rather than always saying ACE inhibitors， beta-blockers and so on， we say GDMT. It is what we say when we mean the years of accumulated evidence that make up the guidelines.

　　《国际循环》：今年AHA/ACC发布了心力衰竭管理指南，提出了GDMT的概念。请您向中国观众介绍一下这一概念？

　　Jessup教授：GDMT是指指南导向药物治疗，简要概述了心力衰竭的所有循证依据。临床试验的大量证据为我们如何治疗心力衰竭患者提供了依据，。对心力衰竭的治疗，我们不再强调要应用ACEI类药物、β受体阻滞剂等药物，而是要坚持GDMT。也就是说这些指南推荐都是以多年积累的证据为基础的。

　　<International Circulation>: The treatment of heart failure with preserved ejection fraction is a challenge. Can you talk about the new guidelines with regard to this disease state?

　　Prof. Jessup: Heart failure with preserved ejection fraction (HFPEF) makes up about 50% of all heart failure and yet unlike low ejection fraction heart failure where we have lots of evidence that makes up GDMT， in HFPEF we haven’t had any significant trials that have shown us that one therapy is more superior than the other. But there are lots of things that we say in the guidelines that we do know. We need to control the patient’s blood pressure in HFPEF. We need to get patients to exercise. Many of them are overweight and we need them to lose weight. And we have to pay attention to their comorbidities. One comorbidity that is very frequently looked for in HFPEF is sleep apnea. Those are the kinds of things that we have written in the guidelines about HFPEF but there are no big trial data as yet.

　　《国际循环》：左室射血分数保留的心力衰竭 (HFpEF）一直是临床治疗的难点。新指南对HFpEF的治疗作了怎样的推荐？

　　Jessup教授：HFpEF占所有心力衰竭的50%。目前我们主要根据有关射血分数减低性心力衰竭的大量证据实施GDMT，而有关就HFpEF而言则尚无相关试验证实某种治疗方法具有优于其他方法的疗效。尽管如此，指南对HFpEF的管理还是作出了推荐。对HFpEF患者，我们需要控制其血压，鼓励其进行体育锻炼。很多HFpEF患者伴有超重，我们需要让他们减重。此外，还要关注合并症。对HFpEF患者而言，最常见的合并症是睡眠呼吸暂停。新指南对HFpEF治疗的上述方面均作了推荐，但尚未得到大型试验数据的证实。

　　<International Circulation>: What impact do you believe these new guidelines will have and hope for them to have， and what difficulties exist with regard to the application and implementation of these guidelines?

　　Prof. Jessup: There is a whole science involved in getting clinicians to implement what is in the guidelines. First you have to write them and in this version of the guidelines we actually incorporated the performance measures that our government has set for heart failure. By writing these down in our own guidelines we are integrating both performance measures and the guidelines that have made up those performance measures. Secondly， we have really tried to talk about the issues that have to happen when a patient gets sent home from the hospital. In the United States， there is a big focus on preventing readmissions back into the hospital. So we really spent a lot of time in this year’s guidelines on the issues that need to be looked at to prevent the patient from coming back to the hospital. I am hoping by spelling these out and having them make up a part of our guidelines， we will be able to improve the care of patients， not just in the hospital but when they leave the hospital.

　　《国际循环》：您认为或希望这些指南对临床实践将产生怎样的影响？其在推广应用方面面临哪些困难？

　　Jessup教授：目前已经有教临床医生将指南推荐付诸行动的专门学科。首先，需要编写指南，在新版指南中我们实际上纳入了政府为心力衰竭所设定的性能指标。通过将其纳入我们自己的指南中，我们将性能指标与指南相结合。其次，我们曾尝试探讨患者出院后的相关问题。在美国，人们极其注重再住院的预防。因此，在编写今年发布的新指南时，我们真的花了大量的时间就预防再住院的问题进行了深入探讨。我希望提出这些问题，并让其成为我们指南中的一部分。只有这样我们才能改善患者在院内及院外的治疗。

　　<International Circulation>: From what you have said， it sounds like there is an emphasis on a more patient-centric approach in these guidelines. Was this an aim?

　　Prof. Jessup: That is absolutely true. Too often we get bogged down in trial data and forget that the trials were made up of individual patients. We do have to make the full circle back to our individual patients， finding out what is important for them， what they want， what is more important with regard to the length of their life or the quality of their life and to really spend a lot of time talking about not only the education of the patient so they can feel empowered to take care of themselves but also to acknowledge their caregivers and how important it is to talk to their caregivers as well. So making the patient the center of all that we do is really important and it shouldn’t have to be a switch but it is a switch for so many of us and the guidelines have to circle back and make the patient the center as well.

　　《国际循环》：您所说的听起来新指南更像强调以患者为中心听您说来，新指南是强调以患者为中心的。是这样的吗？

　　Jessup教授：这是千真万确的。我们常常受试验数据的迷惑，而忘记了试验都是由一个个患者来参与的。我们转一圈后还是要回到个体化的患者身上，找出对他们而言什么最重要，他们需要什么，哪些措施对改善其生活质量、延长其寿命而言最为重要。我们需要花大量的时间对患者及其照护者进行健康教育，让他们知道自我管理的重要性。因此，以患者为中心是非常重要的，也是我们必须要做到的。以患者为中心不是一种责任转移，而是意在强调医生及指南均应围绕患者而进行，最终以患者为中心。