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Rivera-Toquica A, Echeverría LE, Arias-Barrera CA, Mendoza-Beltrán F, Hoyos-Ballesteros DH, Plata-Mosquera CA, Ortega-Madariaga JC, Carvajal-Estupiñán JF, Quintero-Yepes V, Zárate-Correa LC, García-Peña ÁA, Velásquez-López N, Anchique CV, Saldarriaga CI, Gómez-Mesa JE. Adherence to Treatment Guidelines in Ambulatory Heart Failure Patients with Reduced Ejection Fraction in a Latin-American Country: Observational Study of the Colombian Heart Failure Registry (RECOLFACA). Cardiology 2024; 149:228-236. [PMID: 38359813 DOI: 10.1159/000535916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/10/2023] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Although several guidelines recommend that patients with heart failure with reduced ejection fraction (HFrEF) be treated with angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEIs/ARBs) or angiotensin receptor-neprilysin inhibitors (ARNIs), beta-blockers, mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter-2 inhibitor (SGLT2i), there are still several gaps in their prescription and dosage in Colombia. This study aimed to describe the use patterns of HFrEF treatments in the Colombian Heart Failure Registry (RECOLFACA). METHODS Patients with HFrEF enrolled in RECOLFACA during 2017-2019 were included. Heart failure (HF) medication prescription and daily dose were assessed using absolute numbers and proportions. Therapeutic schemes of patients treated by internal medicine specialists were compared with those treated by cardiologists. RESULTS Out of 2,528 patients in the registry, 1,384 (54.7%) had HFrEF. Among those individuals, 88.9% were prescribed beta-blockers, 72.3% with ACEI/ARBs, 67.9% with MRAs, and 13.1% with ARNIs. Moreover, less than a third of the total patients reached the target doses recommended by the European HF guidelines. No significant differences in the therapeutic schemes or target doses were observed between patients treated by internal medicine specialists or cardiologists. CONCLUSION Prescription rates and target dose achievement are suboptimal in Colombia. Nevertheless, RECOLFACA had one of the highest prescription rates of beta-blockers and MRAs compared to some of the most recent HF registries. However, ARNIs remain underprescribed. Continuous registry updates can improve the identification of patients suitable for ARNI and SGLT2i therapy to promote their use in clinical practice.
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Affiliation(s)
- Alex Rivera-Toquica
- Department of Cardiology, Centro Médico para el Corazón, Pereira, Colombia
- Department of Cardiology, Clínica los Rosales, Pereira, Colombia
- Department of Cardiology, Universidad Tecnológica de Pereira, Pereira, Colombia
| | | | | | | | | | | | | | | | | | - Luz Clemencia Zárate-Correa
- Department of Cardiology, Universidad del Valle, Cali, Colombia
- Department of Cardiology, Hospital Universitario del Valle, Cali, Colombia
| | | | | | | | | | - Juan Esteban Gómez-Mesa
- Department of Cardiology, Fundación Valle del Lili, Cali, Colombia
- Department of Health Sciences, Universidad Icesi, Cali, Colombia
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Kobayashi M, Gargani L, Palazzuoli A, Ambrosio G, Bayés-Genis A, Lupon J, Pellicori P, Pugliese NR, Reddy YNV, Ruocco G, Duarte K, Huttin O, Rossignol P, Coiro S, Girerd N. Association between right-sided cardiac function and ultrasound-based pulmonary congestion on acutely decompensated heart failure: findings from a pooled analysis of four cohort studies. Clin Res Cardiol 2020; 110:1181-1192. [PMID: 32770373 DOI: 10.1007/s00392-020-01724-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/28/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Right ventricular (RV) dysfunction and RV-pulmonary artery (PA) uncoupling are associated with the development of pulmonary congestion during exercise. However, there is limited information regarding the association between these right-sided cardiac parameters and pulmonary congestion in acutely decompensated heart failure (HF). METHODS We performed an individual patient meta-analysis from four cohort studies of hospitalized patients with HF who had available lung ultrasound (B-lines) data on admission and/or at discharge. RV function was assessed by tricuspid annular plane systolic excursion (TAPSE), RV-PA coupling was defined as the ratio of TAPSE to PA systolic pressure (PASP). RESULTS Admission and discharge cohort included 319 patients (75.8 ± 10.1 years, 46% women) and 221 patients (77.9 ± 9.0 years, 47% women), respectively. Overall, higher TAPSE was associated with higher ejection fraction, lower PASP, b-type natriuretic peptide and B-line counts. By multivariable analysis, worse RV function or RV-PA coupling was associated with higher B-line counts on admission and at discharge, and with a less reduction in B-line counts from admission to discharge. Higher B-line counts at discharge were associated with a higher risk of the composite of all-cause mortality and/or HF re-hospitalization [adjusted-HR 1.13 (1.09-1.16), p < 0.001]. Furthermore, the absolute risk increase related to high B-line counts at discharge was higher in patients with lower TAPSE. CONCLUSIONS In patients with acutely decompensated HF, impaired RV function and RV-PA coupling were associated with severe pulmonary congestion on admission, and less resolution of pulmonary congestion during hospital stay. Worse prognosis related to residual pulmonary congestion was enhanced in patients with RV dysfunction. TAPSE, tricuspid annular plane systolic excursion; PASP, pulmonary artery systolic pressure.
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Affiliation(s)
- Masatake Kobayashi
- INSERM, Centre d'Investigations Cliniques 1433, CHRU de Nancy, Inserm 1116 and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Institut Lorrain du cœur et des, Université de Lorraine, 4, rue du Morvan, Vandoeuvre-Les-Nancy, 54500, Nancy, France
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit Department of Internal Medicine, University of Siena, Siena, Italy
| | | | - Antoni Bayés-Genis
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Josep Lupon
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Pierpaolo Pellicori
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | | | - Yogesh N V Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Gaetano Ruocco
- Cardiology Division, Regina Montis Regalis Hospital, ASL CN-1, Mondovì, Cuneo, Italy
| | - Kevin Duarte
- INSERM, Centre d'Investigations Cliniques 1433, CHRU de Nancy, Inserm 1116 and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Institut Lorrain du cœur et des, Université de Lorraine, 4, rue du Morvan, Vandoeuvre-Les-Nancy, 54500, Nancy, France
| | - Olivier Huttin
- INSERM, Centre d'Investigations Cliniques 1433, CHRU de Nancy, Inserm 1116 and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Institut Lorrain du cœur et des, Université de Lorraine, 4, rue du Morvan, Vandoeuvre-Les-Nancy, 54500, Nancy, France
| | - Patrick Rossignol
- INSERM, Centre d'Investigations Cliniques 1433, CHRU de Nancy, Inserm 1116 and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Institut Lorrain du cœur et des, Université de Lorraine, 4, rue du Morvan, Vandoeuvre-Les-Nancy, 54500, Nancy, France
| | - Stefano Coiro
- Division of Cardiology, University of Perugia, Perugia, Italy
| | - Nicolas Girerd
- INSERM, Centre d'Investigations Cliniques 1433, CHRU de Nancy, Inserm 1116 and INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Institut Lorrain du cœur et des, Université de Lorraine, 4, rue du Morvan, Vandoeuvre-Les-Nancy, 54500, Nancy, France.
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Tratamiento de la insuficiencia cardiaca en el paciente diabético: ¿Cuáles son las diferencias? REVISTA COLOMBIANA DE CARDIOLOGÍA 2020. [DOI: 10.1016/j.rccar.2019.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Hall TS, von Lueder TG, Zannad F, Rossignol P, Duarte K, Chouihed T, Solomon SD, Dickstein K, Atar D, Agewall S, Girerd N. Left ventricular ejection fraction and adjudicated, cause-specific hospitalizations after myocardial infarction complicated by heart failure or left ventricular dysfunction. Am Heart J 2019; 215:83-90. [PMID: 31291604 DOI: 10.1016/j.ahj.2019.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 06/01/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Reduced left ventricular ejection fraction (LVEF) after acute myocardial infarction (MI) increases risk of cardiovascular (CV) hospitalizations, but evidence regarding its association with non-CV outcome is scarce. We investigated the association between LVEF and adjudicated cause-specific hospitalizations following MI complicated with low LVEF or overt heart failure (HF). METHODS In an individual patient data meta-analysis of 19,740 patients from 3 large randomized trials, Fine and Gray competing risk modeling was performed to study the association between LVEF and hospitalization types. RESULTS The most common cause of hospitalization was non-CV (n = 2,368 for HF, n = 1,554 for MI, and n = 3,703 for non-CV). All types of hospitalizations significantly increased with decreasing LVEF. The absolute risk increase associated with LVEF ≪25% (vs LVEF ≫35%) was 15.5% (95% CI 13.4-17.5) for HF, 4.7% (95% CI 3.0-6.4) for MI, and 10.4% (95% CI 8.0-12.8) for non-CV hospitalization. On a relative scale, after adjusting for confounders, each 5-point decrease in LVEF was associated with an increased risk of HF (hazard ratio [HR] 1.15, 95% CI 1.12-1.18), MI (HR 1.06, 95% CI 1.03-1.10), and non-CV hospitalization (HR 1.03, 95% CI 1.01-1.05). CONCLUSIONS In a high-risk population with complicated acute MI, the absolute risk increase in non-CV hospitalizations associated with LVEF ≪25% was two thirds of the absolute risk increase in HF hospitalizations and twice the absolute risk increase in MI hospitalizations. LVEF was an independent predictor of all types of hospitalization and appears as an integrative marker of sicker patient status.
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Rossello X, Ferreira JP, McMurray JJV, Aguilar D, Pfeffer MA, Pitt B, Dickstein K, Girerd N, Rossignol P, Zannad F. Editor’s Choice- Impact of insulin-treated diabetes on cardiovascular outcomes following high-risk myocardial infarction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 8:231-241. [DOI: 10.1177/2048872618803701] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: Diabetes is associated with poor cardiovascular outcomes, and insulin-treated patients usually have a worse prognosis than non-insulin-treated subjects. The relationship between insulin treatment and outcomes in high-risk myocardial infarction patients has not been described in a large dataset. Methods: To investigate the association between insulin-treated diabetes and long-term cardiovascular outcomes in patients with high-risk myocardial infarction, we used adjusted Cox models to compare cardiovascular mortality and hospitalisation among 28,771 patients grouped by diabetes status and insulin treatment from four randomised clinical trials (VALIANT, EPHESUS, OPTIMAAL, CAPRICORN) of acute myocardial infarction complicated by heart failure and/or left ventricular systolic dysfunction. Results: After an approximately 2-year follow-up, patients with no diabetes (21,386 subjects, 74.3%), non-insulin-treated diabetes (4977 patients, 17.3%) and insulin-treated diabetes (2409 subjects, 8.4%) had an incremental yearly mortality risk (15.8%, 21.3% and 28.1%, respectively). Insulin-treated diabetes patients presented with a higher cardiovascular burden and comorbidities. After adjustment for 18 baseline covariates, patients with non-insulin-treated and insulin-treated diabetes were at higher risk of cardiovascular death (hazard ratio (HR) 1.25, 95% confidence interval (CI) 1.13–1.38 and HR 1.49, 95% CI 1.31–1.69, respectively; P for comparison of non-insulin-treated vs. insulin-treated diabetes =0.016) and cardiovascular hospitalisation (HR 1.33, 95% CI 1.25–1.41 and HR 1.16, 95% CI 1.11–1.22, respectively) compared to patients without diabetes. These results remained consistent after further adjustment for medications and left ventricular ejection fraction. Conclusions: Insulin-treated diabetes patients had higher event rates than diabetes patients taking oral treatments and patients without diabetes. However, insulin-treated diabetes patients had more comorbidities and atherosclerotic disease, precluding any causality suggestion between insulin treatment and outcomes. This high-risk population may require specific and/or more intense cardiovascular protective therapies.
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Affiliation(s)
- Xavier Rossello
- Translational Laboratory for Cardiovascular Imaging and Therapy, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Spain
- CIBER de Enfermedades CardioVasculares, Spain
| | - João Pedro Ferreira
- Université de Lorraine, Centre d’Investigations Cliniques Plurithématique, France
- Department of Physiology and Cardiothoracic Surgery, University of Porto, Portugal
| | | | - David Aguilar
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center at Houston, USA
| | - Marc A Pfeffer
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, USA
| | - Bertram Pitt
- Department of Medicine, University of Michigan School of Medicine, USA
| | | | - Nicolas Girerd
- Université de Lorraine, Centre d’Investigations Cliniques Plurithématique, France
| | - Patrick Rossignol
- Université de Lorraine, Centre d’Investigations Cliniques Plurithématique, France
| | - Faiez Zannad
- Université de Lorraine, Centre d’Investigations Cliniques Plurithématique, France
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Sharma A, Al-Khatib SM, Ezekowitz JA, Cooper LB, Fordyce CB, Michael Felker G, Bardy GH, Poole JE, Thomas Bigger J, Buxton AE, Moss AJ, Friedman DJ, Lee KL, Steinman R, Dorian P, Cappato R, Kadish AH, Kudenchuk PJ, Mark DB, Peterson ED, Inoue LYT, Sanders GD. Implantable cardioverter-defibrillators in heart failure patients with reduced ejection fraction and diabetes. Eur J Heart Fail 2018; 20:1031-1038. [PMID: 29761861 DOI: 10.1002/ejhf.1192] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 03/03/2018] [Accepted: 03/08/2018] [Indexed: 12/28/2022] Open
Abstract
AIM There is limited information on the outcomes after primary prevention implantable cardioverter-defibrillator (ICD) implantation in patients with heart failure (HF) and diabetes. This analysis evaluates the effectiveness of a strategy of ICD plus medical therapy vs. medical therapy alone among patients with HF and diabetes. METHODS AND RESULTS A patient-level combined-analysis was conducted from a combined dataset that included four primary prevention ICD trials of patients with HF or severely reduced ejection fractions: Multicenter Automatic Defibrillator Implantation Trial I (MADIT I), MADIT II, Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation (DEFINITE), and Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). In total, 3359 patients were included in the analysis. The primary outcome of interest was all-cause death. Compared with patients without diabetes (n = 2363), patients with diabetes (n = 996) were older and had a higher burden of cardiovascular risk factors. During a median follow-up of 2.6 years, 437 patients without diabetes died (178 with ICD vs. 259 without) and 280 patients with diabetes died (128 with ICD vs. 152 without). ICDs were associated with a reduced risk of all-cause mortality among patients without diabetes [hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.46-0.67] but not among patients with diabetes (HR 0.88, 95% CI 0.7-1.12; interaction P = 0.015). CONCLUSION Among patients with HF and diabetes, primary prevention ICD in combination with medical therapy vs. medical therapy alone was not significantly associated with a reduced risk of all-cause death. Further studies are needed to evaluate the effectiveness of ICDs among patients with diabetes.
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Affiliation(s)
- Abhinav Sharma
- Duke Clinical Research Institute, Duke University, Durham, NC, USA.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Sana M Al-Khatib
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Justin A Ezekowitz
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Lauren B Cooper
- Duke Clinical Research Institute, Duke University, Durham, NC, USA.,Inova Heart and Vascular Institute, Falls Church, VA, USA
| | | | - G Michael Felker
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Gust H Bardy
- Seattle Institute for Cardiac Research, Seattle, WA, USA
| | | | - J Thomas Bigger
- Department of Medicine, Columbia University, New York, NY, USA
| | - Alfred E Buxton
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Arthur J Moss
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, MN, USA
| | | | - Kerry L Lee
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Richard Steinman
- Irving Institute for Clinical and Translational Research, Columbia University, New York, NY, USA
| | - Paul Dorian
- Departments of Medicine and Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Riccardo Cappato
- IRCCS Policlinico San Donato, Milan, Italy.,Humanitas Clinical And Research Center, via Manzoni 56 20089 Rozzano (Mi).,Humanitas University Department of Biomedical Sciences Via Rita Levi Montalcini 4 Pieve Emanuele (Mi)
| | - Alan H Kadish
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Daniel B Mark
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Lurdes Y T Inoue
- Department of Biostatistics, University of Washington, Seattle, WA, USA
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Ferreira JP, Mentz RJ, Pizard A, Pitt B, Zannad F. Tailoring mineralocorticoid receptor antagonist therapy in heart failure patients: are we moving towards a personalized approach? Eur J Heart Fail 2017; 19:974-986. [DOI: 10.1002/ejhf.814] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 12/30/2016] [Accepted: 02/21/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- João Pedro Ferreira
- Centre d'Investigation Clinique Plurithématique 1433, INSERM U1116; University of Lorraine; Nancy France
- Department of Physiology and Cardiothoracic Surgery; Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto; Porto Portugal
| | - Robert J. Mentz
- Duke Clinical Research Institute and Division of Cardiology, Department of Medicine; Duke University Medical Center; Durham NC USA
| | - Anne Pizard
- Centre d'Investigation Clinique Plurithématique 1433, INSERM U1116; University of Lorraine; Nancy France
| | - Bertram Pitt
- Department of Cardiology; University of Michigan School of Medicine; Ann Arbor MI USA
| | - Faiez Zannad
- Centre d'Investigation Clinique Plurithématique 1433, INSERM U1116; University of Lorraine; Nancy France
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Girerd N, Rabilloud M, Pibarot P, Mathieu P, Roy P. Quantification of Treatment Effect Modification on Both an Additive and Multiplicative Scale. PLoS One 2016; 11:e0153010. [PMID: 27045168 PMCID: PMC4821587 DOI: 10.1371/journal.pone.0153010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/21/2016] [Indexed: 11/29/2022] Open
Abstract
Background In both observational and randomized studies, associations with overall survival are by and large assessed on a multiplicative scale using the Cox model. However, clinicians and clinical researchers have an ardent interest in assessing absolute benefit associated with treatments. In older patients, some studies have reported lower relative treatment effect, which might translate into similar or even greater absolute treatment effect given their high baseline hazard for clinical events. Methods The effect of treatment and the effect modification of treatment were respectively assessed using a multiplicative and an additive hazard model in an analysis adjusted for propensity score in the context of coronary surgery. Results The multiplicative model yielded a lower relative hazard reduction with bilateral internal thoracic artery grafting in older patients (Hazard ratio for interaction/year = 1.03, 95%CI: 1.00 to 1.06, p = 0.05) whereas the additive model reported a similar absolute hazard reduction with increasing age (Delta for interaction/year = 0.10, 95%CI: -0.27 to 0.46, p = 0.61). The number needed to treat derived from the propensity score-adjusted multiplicative model was remarkably similar at the end of the follow-up in patients aged < = 60 and in patients >70. Conclusions The present example demonstrates that a lower treatment effect in older patients on a relative scale can conversely translate into a similar treatment effect on an additive scale due to large baseline hazard differences. Importantly, absolute risk reduction, either crude or adjusted, can be calculated from multiplicative survival models. We advocate for a wider use of the absolute scale, especially using additive hazard models, to assess treatment effect and treatment effect modification.
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Affiliation(s)
- Nicolas Girerd
- INSERM, Centre d’Investigations Cliniques 1433, Université de Lorraine, CHU de Nancy, Institut Lorrain du cœur et des vaisseaux, Nancy, France
- * E-mail:
| | - Muriel Rabilloud
- Hospices Civils de Lyon, Service de Biostatistiques, Lyon, F-69003, France, Université de Lyon, Lyon, F-69000, France, Université Lyon I, Villeurbanne, F-69100, France, CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistiques Santé, Villeurbanne, F-69100, France
| | | | | | - Pascal Roy
- Hospices Civils de Lyon, Service de Biostatistiques, Lyon, F-69003, France, Université de Lyon, Lyon, F-69000, France, Université Lyon I, Villeurbanne, F-69100, France, CNRS, UMR5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistiques Santé, Villeurbanne, F-69100, France
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