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The end of the 20th century marks a pivotal point in the history of cardiovascular medicine. There has been an explosive growth in the knowledge base relevant to the field, with new developments ranging from technology-driven interventional strategies and device therapy to insights into the molecular biology and genetics of cardiovascular disease. At the same time, physicians find themselves in an environment of limited financial resources, managed care, and evidence-based medicine. In an era of rapidly emerging diagnostic and therapeutic choices, the individual physician faces cost considerations and the scrutiny of evidence-based decision making, a trend seen throughout the world.
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