Acronymophilia

The exponential growth of the use of acronyms should be resisted

Eponyms such as Barlow, Carvallo, Master, and Wolff- Parkinson-White were until recently part of the sport of ward rounds. Times have changed. Now acronyms are in fashion. GUSTO, GISSI, ISIS, MRFIT, and TIMI are heard in hospital corridors and convention halls everywhere.

In cardiology acronyms for research trials have grown almost exponentially. In 1992 I compiled a list of acronyms of 244 major cardiological trials.1 An updated version two years later saw the total nearly quadrupled to over 900.2 As acronyms continue to be born almost every day they need to be made easily understandable by, and readily accessible to, clinicians, investigators, and editors of medical journals while their currency is at a peak.

Acronyms are useful because they simplify, facilitate, and accelerate communication. They have become the shorthand of medicine. Physicians, especially cardiologists, like to use or invent these medical timesavers - and are good at the task.

Acronyms of cardiological studies include many anatomical terms such as ARMS, ATLAS, BRAINS, CARDIA, CARDIAC, CAVA, EARS, FACET, HEART, INTIMA, MAST, PROSTATE, RADIUS, and RALES. * Other acronyms show that their inventors must have food on their mind - APRICOT, BIG-MAC, DISH, GUSTO, MOCHA, SALAD, SALT, and TOAST. Still others represent places - MIAMI, NEVADA, PARIS, SIAM, THAMES, and TIBET. Some have a romantic touch - CASANOVA, M- HEART, and KISS-or are common women's names - ELSA, ERICA, EVA, GRACE, MONICA, NORA, PAMELA, PHYLLIS, and RITA. Finally, acronyms beget acronyms; there are beginning to be acronyms within acronyms - AIMS, AMPI, APSIM, ARMS, DPPS, LART, NHEFS, TAPS, and THIS.

Yet with this proliferation the rules should remain the same. When mentioned or used for the first time in a publication all acronyms must be fully explained to avoid confusion,3 avert misinterpretation,4 eliminate guesswork,5 and prevent aggravation.6 Specialists often take for granted that certain trade terms are so evident or self explanatory that they do not bother to define them. Not all readers of medical journals, especially the specialty journals, are so knowledgeable. No wonder some readers of medical journals give up halfway through an article littered with unexplained acronyms or simply stop reading specialty journals.7

Other reasons for spelling out all acronyms at the first mention include clarity and accuracy. Abbreviations or acronyms may mean different things to different people.8 For example, RISK may stand for Regional Studie av Instabil Kranskarlssjukdom or Risk Intervention SKills study9; these are different trials. Many other examples of duplication exist, including AIRE, BEST, CASIS, CAT, CATS, CRAFT, ELSA, EPIC, HERS, HHS, HIS, HIT, HOPE, IMPACT, KFC, LAVA, LIT, MIDAS, NHS, OURS, PACE, PASE, RAPID, SHAPE, SMART, SMILE, SNAP, STEP, SWORD, TAM, TAPS, and TIPE. A few acronyms stand for three different trials - START, TOPS, and PACT (which has yet another meaning for British general practitioners - that is, Prescribing Analysis and Cost da Ta). After my latest updating of the acronyms of clinical trials 2 a second trial appeared with the acronym COMMIT (Comprehensive Multidisciplinary Interventional Trial for regression of coronary artery disease), a third trial appeared with the acronym HIS (Hungarian Isradipine Study), and a fourth trial appeared with the acronym PACT (Plasminogen Activator angioplasty Compatibility Trial). One acronym, CHS, is shared by six trials. If cardiologists cannot avoid inventing new acronyms, they should at least consult the literature to avoid using an acronym that has been used before.

Editors have to accept that acronyms are here to stay. But they should enforce the rule of the International Committee of Medical Journal Editors: the full term for which an acronym stands should precede its first use in the text. Editors should discourage the use of abbreviations and acronyms as a general principle. An article littered with abbreviations and acronyms looks arcane and will turn readers away; to the uninitiated it is as heard to read as alphabet soup. Abbreviations or acronyms should be restricted to the familiar ones that are generally understood and do not need explanations, such as ECG, DNA, and WHO.10 Apart from these, the only phrases that should be abbreviated are those that are cumbersome and repeated frequently throughout an article and that, if spelt out each time, would make the text much longer. Whenever possible this practice should be restricted to one or two abbreviations or acronyms per article. Someone once suggested asking contributors to list alphabetically all acronyms in their articles, either at the end of their articles or at the foot of the first page of each article. To me, to provide a glossary of acronyms with each article would only add fuel to the fire.