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Neuhaus AL, Rombey T, Brunnhuber K, Pieper D. [Towards evidence based research]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 168:82-87. [PMID: 35153162 DOI: 10.1016/j.zefq.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 12/14/2021] [Indexed: 01/05/2023]
Affiliation(s)
- Annika Lena Neuhaus
- Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, Köln, Deutschland
| | - Tanja Rombey
- Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, Köln, Deutschland
| | | | - Dawid Pieper
- Institut für Forschung in der Operativen Medizin (IFOM), Universität Witten/Herdecke, Köln, Deutschland
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Chen Y, Nagendran M, Gomes M, Wharton PV, Raine R, Lambiase PD. Gaps in patient-reported outcome measures in randomized clinical trials of cardiac catheter ablation: a systematic review. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 6:234-242. [DOI: 10.1093/ehjqcco/qcaa022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 11/14/2022]
Abstract
Abstract
The aim of this systematic review was to evaluate randomized clinical trials (RCTs) of cardiac catheter ablation (CCA) and to assess the prevalence, characteristics and reporting standards of clinically relevant patient-reported outcome measures (PROMs). Electronic database searches of Medline, Embase, CENTRAL, and the WHO Trial Registry were conducted in March 2019. The study protocol was registered on PROSPERO (CRD42019133086). Of 7125 records identified, 237 RCTs were included for analysis, representing 35 427 patients with a mean age of 59 years. Only 43 RCTs (18%) reported PROMs of which 27 included a generic PROM that measured health-related quality of life (HRQL) necessary to conduct comparative effectiveness research. There was notable under-representation of certain patient groups—only 31% were women and only 8% were of non-Caucasian ethnicity, in trials which reported such data. The reporting standard of PROMs was highly variable with 8–62% adherence against CONSORT PRO-specific items. In summary, PROMs play a crucial role in determining the clinical and cost-effectiveness of treatments which primarily offer symptomatic improvement, such as CCA. Their underuse significantly limits evaluation of the comparative effectiveness of treatments. Using CCA as an exemplar, there are additional issues of infrequent assessment, poor reporting and under-representation of many population groups. Greater use of PROMs, and specifically validated HRQL questionnaires, is paramount in giving patients a voice in studies, generating more meaningful comparisons between treatments and driving better patient-centred clinical and policy-level decision-making.
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Affiliation(s)
- Yang Chen
- Institute of Cardiovascular Science, University College London, 62 Huntley Street, London WC1E 6DD, UK
| | - Myura Nagendran
- Section of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Manuel Gomes
- Department of Applied Health Research, University College London, Gower Street, London WC1E 6BT, UK
| | - Peter V Wharton
- Cardiac Patient and Patient Member of the Arrhythmia Alliance, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, Gower Street, London WC1E 6BT, UK
| | - Pier D Lambiase
- Institute of Cardiovascular Science, University College London, 62 Huntley Street, London WC1E 6DD, UK
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Cluckey A, Perino AC, Yunus FN, Leef GC, Askari M, Heidenreich PA, Narayan SM, Wang PJ, Turakhia MP. Efficacy of Ablation Lesion Sets in Addition to Pulmonary Vein Isolation for Paroxysmal Atrial Fibrillation: Findings From the SMASH - AF Meta-Analysis Study Cohort. J Am Heart Assoc 2020; 8:e009976. [PMID: 30587059 PMCID: PMC6405732 DOI: 10.1161/jaha.118.009976] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background The objective was to explore the efficacy of ablation lesion sets in addition to pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation. The optimal strategy for catheter ablation of paroxysmal atrial fibrillation is debated. Methods and Results The SMASH‐AF (Systematic Review and Meta‐analysis of Ablation Strategy Heterogeneity in Atrial Fibrillation) study cohort includes trials and observational studies identified in PubMed, Scopus, and Cochrane databases from January 1 1990, to August 1, 2016. We included studies reporting single procedure paroxysmal atrial fibrillation ablation success rates. Exclusion criteria included insufficient reporting of outcomes, ablation strategies that were not prespecified and uniform, and a sample size of fewer than 40 patients. We analyzed lesion sets performed in addition to PVI (PVI plus) using multivariable random‐effects meta‐regression to control for patient, study, and procedure characteristics. The analysis included 145 total studies with 23 263 patients (PVI‐only cohort: 115 studies, 148 treatment arms, 16 500 patients; PVI plus cohort: 39 studies; 46 treatment arms, 6763 patients). PVI plus studies, as compared with PVI‐only studies, included younger patients (56.7 years versus 58.8 years, P=0.001), fewer women (27.2% versus 32.0% women, P=0.002), and were more methodologically rigorous with longer follow‐up (29.5 versus 17.1 months, P 0.004) and more randomization (19.4% versus 11.8%, P<0.001). In multivariable meta‐regression, PVI plus studies were associated with improved success (7.6% absolute improvement [95% CI, 2.6–12.5%]; P<0.01, I2=88%), specifically superior vena cava isolation (4 studies, 4 treatment arms, 1392 patients; 15.1% absolute improvement [95% CI, 2.3–27.9%]; P 0.02, I2=87%). However, residual heterogeneity was large. Conclusions Across the paroxysmal atrial fibrillation ablation literature, PVI plus ablation strategies were associated with incremental improvements in success rate. However, large residual heterogeneity complicates evidence synthesis.
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Affiliation(s)
- Andrew Cluckey
- 1 Department of Medicine Stanford University School of Medicine Stanford CA.,2 Veterans Affairs Palo Alto Health Care System Palo Alto CA
| | - Alexander C Perino
- 1 Department of Medicine Stanford University School of Medicine Stanford CA.,2 Veterans Affairs Palo Alto Health Care System Palo Alto CA
| | - Fahd N Yunus
- 1 Department of Medicine Stanford University School of Medicine Stanford CA.,2 Veterans Affairs Palo Alto Health Care System Palo Alto CA
| | - George C Leef
- 1 Department of Medicine Stanford University School of Medicine Stanford CA.,2 Veterans Affairs Palo Alto Health Care System Palo Alto CA
| | - Mariam Askari
- 2 Veterans Affairs Palo Alto Health Care System Palo Alto CA
| | - Paul A Heidenreich
- 1 Department of Medicine Stanford University School of Medicine Stanford CA.,2 Veterans Affairs Palo Alto Health Care System Palo Alto CA
| | - Sanjiv M Narayan
- 1 Department of Medicine Stanford University School of Medicine Stanford CA.,2 Veterans Affairs Palo Alto Health Care System Palo Alto CA
| | - Paul J Wang
- 1 Department of Medicine Stanford University School of Medicine Stanford CA.,2 Veterans Affairs Palo Alto Health Care System Palo Alto CA
| | - Mintu P Turakhia
- 1 Department of Medicine Stanford University School of Medicine Stanford CA.,2 Veterans Affairs Palo Alto Health Care System Palo Alto CA.,3 Center for Digital Health Stanford University School of Medicine Stanford CA
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Avidan MS, Ioannidis JPA, Mashour GA. Independent discussion sections for improving inferential reproducibility in published research. Br J Anaesth 2019; 122:413-420. [PMID: 30857597 PMCID: PMC6435840 DOI: 10.1016/j.bja.2018.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/11/2018] [Accepted: 12/13/2018] [Indexed: 01/15/2023] Open
Abstract
There is a reproducibility crisis in science. There are many potential contributors to replication failure in research across the translational continuum. In this perspective piece, we focus on the narrow topic of inferential reproducibility. Although replication of methods and results is necessary to demonstrate reproducibility, it is not sufficient. Also fundamental is consistent interpretation in the Discussion section. Current deficiencies in the Discussion sections of manuscripts might limit the inferential reproducibility of scientific research. Lack of contextualisation using systematic reviews, overinterpretation and misinterpretation of results, and insufficient acknowledgement of limitations are common problems in Discussion sections; these deficiencies can harm the translational process. Proposed solutions include eliminating or not reading Discussions, writing accompanying editorials, and post-publication review and comments; however, none of these solutions works very well. A second Discussion written by an independent author with appropriate expertise in research methodology is a new testable solution that could help probe inferential reproducibility, and address some deficiencies in primary Discussion sections.
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Affiliation(s)
- Michael S Avidan
- Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA.
| | - John P A Ioannidis
- Departments of Health Research and Policy, Medicine, Biomedical Data Science, and Statistics, Meta-Research Innovation Center, Stanford University, Palo Alto, CA, USA
| | - George A Mashour
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA
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Perino AC, Leef GC, Cluckey A, Yunus FN, Askari M, Heidenreich PA, Narayan SM, Wang PJ, Turakhia MP. Secular trends in success rate of catheter ablation for atrial fibrillation: The SMASH-AF cohort. Am Heart J 2019; 208:110-119. [PMID: 30502925 DOI: 10.1016/j.ahj.2018.10.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/20/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Approaches, tools, and technologies for atrial fibrillation (AF) ablation have evolved significantly since its inception. We sought to characterize secular trends in AF ablation success rates. METHODS We performed a systematic review and meta-analysis of AF ablation from January 1, 1990, to August 1, 2016, searching PubMed, Scopus, and Cochrane databases. Major exclusion criteria were insufficient outcome reporting and ablation strategies that were not prespecified and uniform. We stratified treatment arms by AF type (paroxysmal AF; nonparoxysmal AF) and analyzed single-procedure outcomes. Multivariate meta-regressions analyzed effects of study, patient, and procedure characteristics on success rate trends. Registered in PROSPERO (CRD42016036549). RESULTS A total of 180 trials and observational studies with 28,118 patients met inclusion. For paroxysmal AF ablation studies, unadjusted success rate summary estimates ranged from 73.1% in 2003 to 77.1% in 2016, increasing by 0.9%/year (95% CI 0.4%-1.4%; P = .001; I2 = 90%). After controlling for study design and patient demographics, rate of improvement in success rate summary estimate increased (1.6%/year; 95% CI 0.9%-2.2%; P = .001; I2 = 87%). For nonparoxysmal AF ablation studies, unadjusted success rate summary estimates ranged from 70.0% in 2010 to 64.3% in 2016 (1.1%/year; 95% CI -1.3% to 3.5%; P = .37; I2 = 85%), with no improvement in multivariate analyses. CONCLUSIONS Despite substantial research investment and health care expenditure, improvements in AF ablation success rates have been incremental. Meaningful improvements may require major paradigm or technology changes, and evaluation of clinical outcomes such as mortality and quality of life may prove to be important going forward.
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Yuan S, Holmqvist F, Kongstad O, Jensen SM, Wang L, Ljungström E, Hertervig E, Borgquist R. Long-term outcomes of the current remote magnetic catheter navigation technique for ablation of atrial fibrillation. SCAND CARDIOVASC J 2017; 51:308-315. [DOI: 10.1080/14017431.2017.1384566] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Shiwen Yuan
- Section of Arrhythmias, Skåne University Hospital, Lund University, Lund, Sweden
| | - Fredrik Holmqvist
- Section of Arrhythmias, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ole Kongstad
- Section of Arrhythmias, Skåne University Hospital, Lund University, Lund, Sweden
| | - Steen M. Jensen
- Section of Arrhythmias, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lingwei Wang
- Section of Arrhythmias, Skåne University Hospital, Lund University, Lund, Sweden
| | - Erik Ljungström
- Section of Arrhythmias, Skåne University Hospital, Lund University, Lund, Sweden
| | - Eva Hertervig
- Section of Arrhythmias, Skåne University Hospital, Lund University, Lund, Sweden
| | - Rasmus Borgquist
- Section of Arrhythmias, Skåne University Hospital, Lund University, Lund, Sweden
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Duyx B, Urlings MJ, Swaen GM, Bouter LM, Zeegers MP. Scientific citations favor positive results: a systematic review and meta-analysis. J Clin Epidemiol 2017; 88:92-101. [DOI: 10.1016/j.jclinepi.2017.06.002] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 05/15/2017] [Accepted: 06/03/2017] [Indexed: 10/19/2022]
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Trinquart L, Johns DM, Galea S. Why do we think we know what we know? A metaknowledge analysis of the salt controversy. Int J Epidemiol 2016; 45:251-60. [PMID: 26888870 DOI: 10.1093/ije/dyv184] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although several public health organizations have recommended population-wide reduction in salt intake, the evidence on the population benefits remains unclear. We conducted a metaknowledge analysis of the literature on salt intake and health outcomes. METHODS We identified reports--primary studies, systematic reviews, guidelines and comments, letters or reviews--addressing the effect of sodium intake on cerebro-cardiovascular disease or mortality. We classified reports as supportive or contradictory of the hypothesis that salt reduction leads to population benefits, and constructed a network of citations connecting these reports. We tested for citation bias using an exponential random graph model. We also assessed the inclusion of primary studies in systematic reviews on the topic. RESULTS We identified 269 reports (25% primary studies, 5% systematic reviews, 4% guidelines and 66% comments, letters, or reviews) from between 1978 and 2014. Of these, 54% were supportive of the hypothesis, 33% were contradictory and 13% were inconclusive. Reports were 1.51 [95% confidence interval (CI) 1.38 to 1.65] times more likely to cite reports that drew a similar conclusion, than to cite reports drawing a different conclusion. In all, 48 primary studies were selected for inclusion across 10 systematic reviews. If any given primary study was selected by a review, the probability that a further review would also have selected it was 27.0% (95% CI 20.3% to 33.7%). CONCLUSIONS We documented a strong polarization of scientific reports on the link between sodium intake and health outcomes, and a pattern of uncertainty in systematic reviews about what should count as evidence.
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Affiliation(s)
| | - David Merritt Johns
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Chang AY, Kaiser D, Ullal A, Perino AC, Heidenreich PA, Turakhia MP. Evaluating the Cost-effectiveness of Catheter Ablation of Atrial Fibrillation. Arrhythm Electrophysiol Rev 2014; 3:177-83. [PMID: 26835088 DOI: 10.15420/aer.2014.3.3.177] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 11/22/2014] [Indexed: 01/01/2023] Open
Abstract
Atrial fibrillation (AF) is one of the most common cardiac conditions treated in primary care and specialty cardiology settings, and is associated with considerable morbidity, mortality and cost. Catheter ablation, typically by electrically isolating the pulmonary veins and surrounding tissue, is more effective at maintaining sinus rhythm than conventional antiarrhythmic drug therapy and is now recommended as first-line therapy. From a value standpoint, the cost-effectiveness of ablation must incorporate the upfront procedural costs and risks with the benefits of longer term improvements in quality of life (QOL) and healthcare utilisation. Here, we present a primer on cost-effectiveness analysis (CEA), review the data on cost-effectiveness of AF ablation and outline key areas for further investigation.
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Affiliation(s)
- Andrew Y Chang
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Daniel Kaiser
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Aditya Ullal
- Veterans Affairs Palo Alto Health Care System, California, US
| | - Alexander C Perino
- Department of Medicine, Stanford University School of Medicine, Stanford, California; Veterans Affairs Palo Alto Health Care System, California, US
| | - Paul A Heidenreich
- Department of Medicine, Stanford University School of Medicine, Stanford, California; Veterans Affairs Palo Alto Health Care System, California, US
| | - Mintu P Turakhia
- Department of Medicine, Stanford University School of Medicine, Stanford, California; Veterans Affairs Palo Alto Health Care System, California, US
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