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McErlean M, Samways J, Godolphin PJ, Chen Y. The reporting standards of randomised controlled trials in leading medical journals between 2019 and 2020: a systematic review. Ir J Med Sci 2023; 192:73-80. [PMID: 35237908 PMCID: PMC8890950 DOI: 10.1007/s11845-022-02955-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/09/2022] [Indexed: 02/04/2023]
Abstract
Randomised controlled trials (RCTs) are the gold standard study design used to evaluate the safety and effectiveness of healthcare interventions. The reporting quality of RCTs is of fundamental importance for readers to appropriately analyse and understand the design and results of studies which are often labelled as practice changing papers. The aim of this article is to assess the reporting standards of a representative sample of randomised controlled trials (RCTs) published between 2019 and 2020 in four of the highest impact factor general medical journals. A systematic review of the electronic database Medline was conducted. Eligible RCTs included those published in the New England Journal of Medicine, Lancet, Journal of the American Medical Association, and British Medical Journal between January 1, 2019, and June 9, 2020. The study protocol was registered on medRxiv ( https://doi.org/10.1101/2020.07.06.20147074 ). Of a total eligible sample of 497 studies, 50 full-text RCTs were reviewed against the CONSORT 2010 statement and relevant extensions where necessary. The mean adherence to the CONSORT checklist was 90% (SD 9%). There were specific items on the CONSORT checklist which had recurring suboptimal adherence, including in title (item 1a, 70% adherence), randomisation (items 9 and 10, 56% and 30% adherence) and outcomes and estimation (item 17b, 62% adherence). Amongst a sample of RCTs published in four of the highest impact factor general medical journals, there was good overall adherence to the CONSORT 2010 statement. However there remains significant room for improvement in areas such as description of allocation concealment and implementation of randomisation.
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Affiliation(s)
| | - Jack Samways
- grid.439803.5Cardiology Department, London North West University Healthcare NHS Trust, London, UK
| | - Peter J. Godolphin
- grid.83440.3b0000000121901201MRC Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Yang Chen
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK.
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Eliya Y, Averbuch T, Le N, Xie F, Thabane L, Mamas MA, Van Spall HGC. Temporal Trends and Factors Associated With the Inclusion of Patient-Reported Outcomes in Heart Failure Randomized Controlled Trials: A Systematic Review. J Am Heart Assoc 2021; 10:e022353. [PMID: 34689608 PMCID: PMC8751837 DOI: 10.1161/jaha.121.022353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Patient‐reported outcomes (PROs) are important measures of treatment response in heart failure. We assessed temporal trends in and factors associated with inclusion of PROs in heart failure randomized controlled trials (RCTs). Methods and Results We searched MEDLINE, Embase, and CINAHL for studies published between January 2000 and July 2020 in journals with an impact factor ≥10. We assessed temporal trends using the Jonckheere‐Terpstra test and conducted multivariable logistic regression to explore trial characteristics associated with PRO inclusion. We assessed the quality of PRO reporting using the Consolidated Standards of Reporting Trials (CONSORT) PRO extension. Of 417 RCTs included, PROs were reported in 226 (54.2%; 95% CI, 49.3%–59.1%), with increased reporting between 2000 and 2020 (P<0.001). The odds of PRO inclusion were greater in RCTs that were published in recent years (adjusted odds ratio [aOR] per year, 1.08; 95% CI, 1.04–1.12; P<0.001), multicenter (aOR, 1.89; 95% CI, 1.03–3.46; P=0.040), medium‐sized (aOR, 2.35; 95% CI, 1.26–4.40; P=0.008), coordinated in Central and South America (aOR, 5.93; 95% CI, 1.14–30.97; P=0.035), and tested health service (aOR, 3.12; 95% CI, 1.49–6.55; P=0.003), device/surgical (aOR, 6.66; 95% CI, 3.15–14.05; P<0.001), or exercise (aOR, 4.66; 95% CI, 1.81–12.00; P=0.001) interventions. RCTs reported a median of 4 (interquartile interval , 3–6) of a possible of 11 CONSORT PRO items. Conclusions Just over half of all heart failure RCTs published in high impact factor journals between 2000 and 2020 included PROs, with increased inclusion of PROs over time. Trials that were large, tested pharmaceutical interventions, and coordinated in North America / Europe had lower adjusted odds of reporting PROs relative to other trials. The quality of PRO reporting was modest.
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Affiliation(s)
- Yousif Eliya
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Ontario Canada
| | - Tauben Averbuch
- Department of Medicine McMaster University Hamilton Ontario Canada
| | - NhatChinh Le
- Department of Medicine McMaster University Hamilton Ontario Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Ontario Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Ontario Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group Keele University Stroke-on-Trent United Kingdom
| | - Harriette G C Van Spall
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Ontario Canada.,Department of Medicine McMaster University Hamilton Ontario Canada.,Population Health Research Institute Hamilton Ontario Canada
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Hu ZJ, Fusch G, Hu C, Wang JY, El Helou Z, Hassan MT, Mbuagbaw L, El Helou S, Thabane L. Completeness of reporting of quality improvement studies in neonatology is inadequate: a systematic literature survey. BMJ Open Qual 2021; 10:bmjoq-2020-001273. [PMID: 34127453 PMCID: PMC8204179 DOI: 10.1136/bmjoq-2020-001273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 06/02/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Quality improvement (QI) is a growing field of inquiry in healthcare, but the reporting quality of QI studies in neonatology remains unclear. We conducted a systematic survey of the literature to assess the reporting quality of QI studies and factors associated with reporting quality. METHODS We searched Medline for publications of QI studies from 2016 to 16 April 2020. Pairs of reviewers independently screened citations and assessed reporting quality using a 31-item modified Standards for Quality Improvement Reporting Excellence, 2nd edition (SQUIRE 2.0) checklist. We reported the number (percentage) of studies that reported each item and their corresponding 95% CIs. We used Poisson regression to explore factors associated with reporting quality, namely, journal endorsement of SQUIRE 2.0, declaration of funding sources, year of publication and number of authors. The results were reported as incidence rate ratio (IRR) and 95% CI. RESULTS Of 1921 citations, 336 were eligible; among them, we randomly selected 100 articles to assess reporting quality. The mean (standard deviation) number of SQUIRE 2.0 items adhered to was 22.0 (4.5). Percentage of articles reporting each item varied from 26% to 100%. Journal endorsement of SQUIRE 2.0 (IRR=1.11, 95% CI 1.02 to 1.21, p=0.015), declaration of funding sources and increasing number of authors were significantly associated with better reporting. CONCLUSIONS Reporting quality of QI studies in neonatology is inadequate. Endorsing the SQUIRE 2.0 guideline is a step that journals can implement to enhance the completeness of reporting.
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Affiliation(s)
- Zheng Jing Hu
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gerhard Fusch
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Catherine Hu
- Bachelor of Arts and Science, McMaster University, Hamilton, Ontario, Canada
| | - Jie Yi Wang
- Bachelor of Medical Sciences, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Zoe El Helou
- Bachelor of Health Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Muhammad Taaha Hassan
- Bachelor of Health Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Salhab El Helou
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Santilli F, Simeone P. Aspirin in primary prevention: the triumph of clinical judgement over complex equations. Intern Emerg Med 2019; 14:1217-1231. [PMID: 31542891 DOI: 10.1007/s11739-019-02191-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Accepted: 09/04/2019] [Indexed: 12/21/2022]
Abstract
Aspirin, in 2017, has celebrated its 120th birthday. The efficacy and safety of low-dose aspirin in secondary prevention of cardiovascular disease is well supported by many studies, instead in primary prevention it remains controversial, especially in the aftermath of the publication in 2018 of three novel primary prevention randomized clinical trials, showing that the benefit of low-dose aspirin, although additive to that of statin, is counterbalanced by an excess of (mainly gastrointestinal) bleeding events. The signal for a net benefit seems to be even more controversial in the elderly starting aspirin after the age of 70 years. While international guidelines have promptly downgraded their recommendations to more conservative indications, the practicing clinician is called to make the effort to individualize the treatment, after careful evaluation of the haemorrhagic risk vis-a-vis the risk to develop, in the mid-term and long-term follow-up, major cardiovascular events or cancer. This is a particularly complex task, given the different immediate and long-term impact of diverse outcomes on health, the dynamic nature over time of the benefit/risk balance, prompting periodic re-assessments of its indication, and the interindividual variability in aspirin response. The chemopreventive properties of aspirin, anticipated by a large body of epidemiological and mechanistic evidence, are awaiting their final confirmation by the long-term follow-up of the latest trials specifically designed to assess this endpoint, with the expectation to subvert the delicate benefit/risk balance of aspirin in primary prevention. This review is intended to provide an interpretation of past and current evidence to guide clinical decision making on the contemporary patient.
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Affiliation(s)
- Francesca Santilli
- Department of Medicine and Aging, and Center of Aging Science and Translational Medicine (CESI-Met), "G. D'Annunzio" University Foundation School of Medicine, Via Luigi Polacchi, 66013, Chieti, Italy.
| | - Paola Simeone
- Department of Medicine and Aging, and Center of Aging Science and Translational Medicine (CESI-Met), "G. D'Annunzio" University Foundation School of Medicine, Via Luigi Polacchi, 66013, Chieti, Italy
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Liampas I, Chlinos A, Siokas V, Brotis A, Dardiotis E. Assessment of the reporting quality of RCTs for novel oral anticoagulants in venous thromboembolic disease based on the CONSORT statement. J Thromb Thrombolysis 2019; 48:542-553. [DOI: 10.1007/s11239-019-01931-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Zheng SL, Roddick AJ. Association of Aspirin Use for Primary Prevention With Cardiovascular Events and Bleeding Events: A Systematic Review and Meta-analysis. JAMA 2019; 321:277-287. [PMID: 30667501 PMCID: PMC6439678 DOI: 10.1001/jama.2018.20578] [Citation(s) in RCA: 348] [Impact Index Per Article: 69.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE The role for aspirin in cardiovascular primary prevention remains controversial, with potential benefits limited by an increased bleeding risk. OBJECTIVE To assess the association of aspirin use for primary prevention with cardiovascular events and bleeding. DATA SOURCES PubMed and Embase were searched on Cochrane Library Central Register of Controlled Trials from the earliest available date through November 1, 2018. STUDY SELECTION Randomized clinical trials enrolling at least 1000 participants with no known cardiovascular disease and a follow-up of at least 12 months were included. Included studies compared aspirin use with no aspirin (placebo or no treatment). DATA EXTRACTION AND SYNTHESIS Data were screened and extracted independently by both investigators. Bayesian and frequentist meta-analyses were performed. MAIN OUTCOMES AND MEASURES The primary cardiovascular outcome was a composite of cardiovascular mortality, nonfatal myocardial infarction, and nonfatal stroke. The primary bleeding outcome was any major bleeding (defined by the individual studies). RESULTS A total of 13 trials randomizing 164 225 participants with 1 050 511 participant-years of follow-up were included. The median age of trial participants was 62 years (range, 53-74), 77 501 (47%) were men, 30 361 (19%) had diabetes, and the median baseline risk of the primary cardiovascular outcome was 9.2% (range, 2.6%-15.9%). Aspirin use was associated with significant reductions in the composite cardiovascular outcome compared with no aspirin (57.1 per 10 000 participant-years with aspirin and 61.4 per 10 000 participant-years with no aspirin) (hazard ratio [HR], 0.89 [95% credible interval, 0.84-0.95]; absolute risk reduction, 0.38% [95% CI, 0.20%-0.55%]; number needed to treat, 265). Aspirin use was associated with an increased risk of major bleeding events compared with no aspirin (23.1 per 10 000 participant-years with aspirin and 16.4 per 10 000 participant-years with no aspirin) (HR, 1.43 [95% credible interval, 1.30-1.56]; absolute risk increase, 0.47% [95% CI, 0.34%-0.62%]; number needed to harm, 210). CONCLUSIONS AND RELEVANCE The use of aspirin in individuals without cardiovascular disease was associated with a lower risk of cardiovascular events and an increased risk of major bleeding. This information may inform discussions with patients about aspirin for primary prevention of cardiovascular events and bleeding.
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Affiliation(s)
- Sean L. Zheng
- Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Cardiology, King’s College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom
- Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| | - Alistair J. Roddick
- Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
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Chen Z, Hong Y, Liu N, Zhang Z. Quality of critical care clinical practice guidelines: Assessment with AGREE II instrument. J Clin Anesth 2018; 51:40-47. [PMID: 30092459 DOI: 10.1016/j.jclinane.2018.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/24/2018] [Accepted: 08/04/2018] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVE Clinical practice guidelines (CPGs) are cornerstones for the management of critically ill patients. Numerous CPGs have been generated in critical care medicine, but their qualities have never been systematically appraised. The aim of the present study was to systematically assess the quality of critical care CPGs. DESIGN A systematic electronic search was performed in PubMed and Scopus. All critical care CPGs were included for analysis. SETTING Not applicable. PATIENTS Not applicable. INTERVENTION None. MEASUREMENTS The Appraisal of guidelines for research & evaluation II (AGREE II) instrument was employed to appraise the quality. CPGs were assessed independently by three raters and intraclass correlation coefficient to represent the agreement among raters. MAIN RESULTS A total of 89 CPGs were included for quantitative analysis. The results showed that domain 1 (scope and purpose) had the highest scores (0.93, IQR: 0.89-0.98) and domain 2 (stakeholder involvement) had the lowest scores (0.37, IQR: 0.30-0.46). The overall score was 0.83 (IQR: 0.67-0.83). Publication year was not associated with scaled scores in each domain. Domain 2 (stakeholder involvement) was significantly associated with the number of societies (coefficient: 0.702, p = 0.033). Also, greater number of societies were associated with higher scaled scores of domain 3 (coefficient: 0.768, p = 0.027), 4 (coefficient: 0.730, p = 0.029) and 5 (coefficient: 0.995, p = 0.023). CONCLUSIONS The study showed that the reporting quality of critical care CPGs were suboptimal. The reporting quality varied across the six domains, with the highest quality in domain 1 and lowest quality in domain 2. Strenuous efforts need to be made to improve the reporting of critical care CPGs.
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Affiliation(s)
- Zhonghua Chen
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Yucai Hong
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Ning Liu
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
| | - Zhongheng Zhang
- Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
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Jin Y, Sanger N, Shams I, Luo C, Shahid H, Li G, Bhatt M, Zielinski L, Bantoto B, Wang M, Abbade LP, Nwosu I, Leenus A, Mbuagbaw L, Maaz M, Chang Y, Sun G, Levine MA, Adachi JD, Thabane L, Samaan Z. Does the medical literature remain inadequately described despite having reporting guidelines for 21 years? - A systematic review of reviews: an update. J Multidiscip Healthc 2018; 11:495-510. [PMID: 30310289 PMCID: PMC6166749 DOI: 10.2147/jmdh.s155103] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Reporting guidelines (eg, Consolidated Standards of Reporting Trials [CONSORT] statement) are intended to improve reporting standards and enhance the transparency and reproducibility of research findings. Despite accessibility of such guidelines, researchers are not required to adhere to them. Our goal was to determine the current status of reporting quality in the medical literature and examine whether adherence of reporting guidelines has improved since the inception of reporting guidelines. MATERIALS AND METHODS Eight reporting guidelines, such as CONSORT, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), STrengthening the Reporting of OBservational studies in Epidemiology (STROBE), Quality of Reporting of Meta-analysis (QUOROM), STAndards for Reporting of Diagnostic accuracy (STARD), Animal Research: Reporting In Vivo Experiments (ARRIVE), Consolidated Health Economic Evaluation Reporting Standards (CHEERS), and Meta-analysis of Observational Studies in Epidemiology (MOOSE) were examined. Our inclusion criteria included reviews published between January 1996 to September 2016 which investigated the adherence to reporting guidelines in the literature that addressed clinical trials, systematic reviews, observational studies, meta-analysis, diagnostic accuracy, economic evaluations, and preclinical animal studies that were in English. All reviews were found on Web of Science, Excerpta Medical Database (EMBASE), MEDLINE, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). RESULTS Among the general searching of 26,819 studies by using the designed searching method, 124 studies were included post screening. We found that 87.9% of the included studies reported suboptimal adherence to reporting guidelines. Factors associated with poor adherence included non-pharmacological interventions, year of publication, and trials concluding with significant results. Improved adherence was associated with better study designs such as allocation concealment, random sequence, large sample sizes, adequately powered studies, multiple authorships, and being published in journals endorsing guidelines. CONCLUSION We conclude that the level of adherence to reporting guidelines remains suboptimal. Endorsement of reporting guidelines by journals is important and recommended.
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Affiliation(s)
- Yanling Jin
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Nitika Sanger
- Department of Medical Science, Medical Sciences Graduate Program, McMaster University, Hamilton, ON, Canada
| | - Ieta Shams
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Candice Luo
- Faculty of Health Sciences, Bachelors of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Hamnah Shahid
- Department of Arts and Science, McMaster University, Hamilton, ON, Canada
| | - Guowei Li
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Meha Bhatt
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Laura Zielinski
- Department of Neuroscience, McMaster Integrative Neuroscience Discovery and Study, McMaster University, Hamilton, ON, Canada
| | - Bianca Bantoto
- Department of Science, Honours Integrated Sciences Program, McMaster University, Hamilton, ON, Canada
| | - Mei Wang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Luciana Pf Abbade
- Department of Dermatology and Radiotherapy, Botucatu Medical School, Universidade Estadual Paulista, UNESP, São Paulo, Brazil
| | - Ikunna Nwosu
- Faculty of Health Sciences, Bachelors of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Alvin Leenus
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Muhammad Maaz
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Yaping Chang
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Guangwen Sun
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
| | - Mitchell Ah Levine
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
- St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Jonathan D Adachi
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
- St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
- St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Zainab Samaan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada,
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada,
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Zheng SL, Roddick AJ, Aghar-Jaffar R, Shun-Shin MJ, Francis D, Oliver N, Meeran K. Association Between Use of Sodium-Glucose Cotransporter 2 Inhibitors, Glucagon-like Peptide 1 Agonists, and Dipeptidyl Peptidase 4 Inhibitors With All-Cause Mortality in Patients With Type 2 Diabetes: A Systematic Review and Meta-analysis. JAMA 2018; 319:1580-1591. [PMID: 29677303 PMCID: PMC5933330 DOI: 10.1001/jama.2018.3024] [Citation(s) in RCA: 257] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IMPORTANCE The comparative clinical efficacy of sodium-glucose cotransporter 2 (SGLT-2) inhibitors, glucagon-like peptide 1 (GLP-1) agonists, and dipeptidyl peptidase 4 (DPP-4) inhibitors for treatment of type 2 diabetes is unknown. OBJECTIVE To compare the efficacies of SGLT-2 inhibitors, GLP-1 agonists, and DPP-4 inhibitors on mortality and cardiovascular end points using network meta-analysis. DATA SOURCES MEDLINE, Embase, Cochrane Library Central Register of Controlled Trials, and published meta-analyses from inception through October 11, 2017. STUDY SELECTION Randomized clinical trials enrolling participants with type 2 diabetes and a follow-up of at least 12 weeks were included, for which SGLT-2 inhibitors, GLP-1 agonists, and DPP-4 inhibitors were compared with either each other or placebo or no treatment. DATA EXTRACTION AND SYNTHESIS Data were screened by 1 investigator and extracted in duplicate by 2 investigators. A Bayesian hierarchical network meta-analysis was performed. MAIN OUTCOMES AND MEASURES The primary outcome: all-cause mortality; secondary outcomes: cardiovascular (CV) mortality, heart failure (HF) events, myocardial infarction (MI), unstable angina, and stroke; safety end points: adverse events and hypoglycemia. RESULTS This network meta-analysis of 236 trials randomizing 176 310 participants found SGLT-2 inhibitors (absolute risk difference [RD], -1.0%; hazard ratio [HR], 0.80 [95% credible interval {CrI}, 0.71 to 0.89]) and GLP-1 agonists (absolute RD, -0.6%; HR, 0.88 [95% CrI, 0.81 to 0.94]) were associated with significantly lower all-cause mortality than the control groups. SGLT-2 inhibitors (absolute RD, -0.9%; HR, 0.78 [95% CrI, 0.68 to 0.90]) and GLP-1 agonists (absolute RD, -0.5%; HR, 0.86 [95% CrI, 0.77 to 0.96]) were associated with lower mortality than were DPP-4 inhibitors. DPP-4 inhibitors were not significantly associated with lower all-cause mortality (absolute RD, 0.1%; HR, 1.02 [95% CrI, 0.94 to 1.11]) than were the control groups. SGLT-2 inhibitors (absolute RD, -0.8%; HR, 0.79 [95% CrI, 0.69 to 0.91]) and GLP-1 agonists (absolute RD, -0.5%; HR, 0.85 [95% CrI, 0.77 to 0.94]) were significantly associated with lower CV mortality than were the control groups. SGLT-2 inhibitors were significantly associated with lower rates of HF events (absolute RD, -1.1%; HR, 0.62 [95% CrI, 0.54 to 0.72]) and MI (absolute RD, -0.6%; HR, 0.86 [95% CrI, 0.77 to 0.97]) than were the control groups. GLP-1 agonists were associated with a higher risk of adverse events leading to trial withdrawal than were SGLT-2 inhibitors (absolute RD, 5.8%; HR, 1.80 [95% CrI, 1.44 to 2.25]) and DPP-4 inhibitors (absolute RD, 3.1%; HR, 1.93 [95% CrI, 1.59 to 2.35]). CONCLUSIONS AND RELEVANCE In this network meta-analysis, the use of SGLT-2 inhibitors or GLP-1 agonists was associated with lower mortality than DPP-4 inhibitors or placebo or no treatment. Use of DPP-4 inhibitors was not associated with lower mortality than placebo or no treatment.
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Affiliation(s)
- Sean L. Zheng
- Department of Endocrinology, Imperial College Healthcare NHS Foundation Trust, London, United Kingdom
- Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
- Imperial College London, United Kingdom
| | - Alistair J. Roddick
- Faculty of Life Sciences and Medicine, King’s College London, United Kingdom
| | - Rochan Aghar-Jaffar
- Department of Endocrinology, Imperial College Healthcare NHS Foundation Trust, London, United Kingdom
- Imperial College London, United Kingdom
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, United Kingdom
| | | | | | - Nick Oliver
- Department of Endocrinology, Imperial College Healthcare NHS Foundation Trust, London, United Kingdom
- Imperial College London, United Kingdom
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, United Kingdom
| | - Karim Meeran
- Department of Endocrinology, Imperial College Healthcare NHS Foundation Trust, London, United Kingdom
- Imperial College London, United Kingdom
- Division of Diabetes, Endocrinology and Metabolism, Imperial College London, United Kingdom
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10
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Mathes T, Klaßen P, Pieper D. Frequency of data extraction errors and methods to increase data extraction quality: a methodological review. BMC Med Res Methodol 2017; 17:152. [PMID: 29179685 PMCID: PMC5704562 DOI: 10.1186/s12874-017-0431-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 11/15/2017] [Indexed: 01/24/2023] Open
Abstract
Background Our objective was to assess the frequency of data extraction errors and its potential impact on results in systematic reviews. Furthermore, we evaluated the effect of different extraction methods, reviewer characteristics and reviewer training on error rates and results. Methods We performed a systematic review of methodological literature in PubMed, Cochrane methodological registry, and by manual searches (12/2016). Studies were selected by two reviewers independently. Data were extracted in standardized tables by one reviewer and verified by a second. Results The analysis included six studies; four studies on extraction error frequency, one study comparing different reviewer extraction methods and two studies comparing different reviewer characteristics. We did not find a study on reviewer training. There was a high rate of extraction errors (up to 50%). Errors often had an influence on effect estimates. Different data extraction methods and reviewer characteristics had moderate effect on extraction error rates and effect estimates. Conclusion The evidence base for established standards of data extraction seems weak despite the high prevalence of extraction errors. More comparative studies are needed to get deeper insights into the influence of different extraction methods. Electronic supplementary material The online version of this article (10.1186/s12874-017-0431-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tim Mathes
- Institute for Research in Operative Medicinem, Chair of Surgical Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany.
| | - Pauline Klaßen
- Institute for Research in Operative Medicinem, Chair of Surgical Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicinem, Chair of Surgical Research, Faculty of Health, School of Medicine, Witten/Herdecke University, Ostmerheimer Str. 200, 51109, Cologne, Germany
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11
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Sims MT, Bowers AM, Fernan JM, Dormire KD, Herrington JM, Vassar M. Trial registration and adherence to reporting guidelines in cardiovascular journals. Heart 2017; 104:753-759. [DOI: 10.1136/heartjnl-2017-312165] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/26/2017] [Accepted: 09/28/2017] [Indexed: 01/05/2023] Open
Abstract
ObjectiveThis study investigated the policies of cardiac and cardiovascular system journals concerning clinical trial registration and guideline adoption to understand how frequently journals use these mechanisms to improve transparency, trial reporting and overall study quality.MethodsWe selected the top 20 (by impact factor) journals cited in the subcategory ‘Cardiac and Cardiovascular Systems’ of the Expanded Science Citation Index of the 2014 Journal Citation Reports to extract journal policies concerning the 17 guidelines we identified. In addition, trial and systematic review registration adherence statements were extracted. 300 randomised controlled trials published in 2016 in the top 20 journals were searched for clinical trial registry numbers and CONSORT diagrams.ResultsOf the 19 cardiac and cardiovascular system journals included in our analysis, eight journals (42%) did not require or recommend trial or review registration. Seven (37%) did not recommend or require a single guideline within their instructions to authors. Consolidated Standards for Reporting Trials guidelines (10/19, 53%) were recommended or required most often. Of the trials surveyed, 122/285 (42.8%) published a CONSORT diagram in their manuscript, while 236/292 (80.8%) published a trial registry number.DiscussionCardiac and cardiovascular system journals infrequently require, recommend or enforce the use of reporting guidelines. Furthermore, too few require or enforce the use of clinical trial registration. Cardiology journal editors should consider guideline adoption due to their potential to limit bias and increase transparency.
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12
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Zheng SL, Chan FT, Nabeebaccus AA, Shah AM, McDonagh T, Okonko DO, Ayis S. Drug treatment effects on outcomes in heart failure with preserved ejection fraction: a systematic review and meta-analysis. Heart 2017; 104:407-415. [PMID: 28780577 PMCID: PMC5861385 DOI: 10.1136/heartjnl-2017-311652] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 06/19/2017] [Accepted: 07/05/2017] [Indexed: 02/06/2023] Open
Abstract
Background Clinical drug trials in patients with heart failure and preserved ejection fraction have failed to demonstrate improvements in mortality. Methods We systematically searched Medline, Embase and the Cochrane Central Register of Controlled Trials for randomised controlled trials (RCT) assessing pharmacological treatments in patients with heart failure with left ventricular (LV) ejection fraction≥40% from January 1996 to May 2016. The primary efficacy outcome was all-cause mortality. Secondary outcomes were cardiovascular mortality, heart failure hospitalisation, exercise capacity (6-min walk distance, exercise duration, VO2 max), quality of life and biomarkers (B-type natriuretic peptide, N-terminal pro-B-type natriuretic peptide). Random-effects models were used to estimate pooled relative risks (RR) for the binary outcomes, and weighted mean differences for continuous outcomes, with 95% CI. Results We included data from 25 RCTs comprising data for 18101 patients. All-cause mortality was reduced with beta-blocker therapy compared with placebo (RR: 0.78, 95%CI 0.65 to 0.94, p=0.008). There was no effect seen with ACE inhibitors, aldosterone receptor blockers, mineralocorticoid receptor antagonists and other drug classes, compared with placebo. Similar results were observed for cardiovascular mortality. No single drug class reduced heart failure hospitalisation compared with placebo. Conclusion The efficacy of treatments in patients with heart failure and an LV ejection fraction≥40% differ depending on the type of therapy, with beta-blockers demonstrating reductions in all-cause and cardiovascular mortality. Further trials are warranted to confirm treatment effects of beta-blockers in this patient group.
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Affiliation(s)
- Sean Lee Zheng
- Cardiovascular Division, King's College Hospital London, British Heart Foundation Centre of Research Excellence, London, UK.,Department of Cardiovascular Medicine, King's College Hospital, London, UK.,Imperial College Healthcare NHS Trust, London, UK
| | - Fiona T Chan
- Imperial College Healthcare NHS Trust, London, UK
| | - Adam A Nabeebaccus
- Cardiovascular Division, King's College Hospital London, British Heart Foundation Centre of Research Excellence, London, UK.,Department of Cardiovascular Medicine, King's College Hospital, London, UK
| | - Ajay M Shah
- Cardiovascular Division, King's College Hospital London, British Heart Foundation Centre of Research Excellence, London, UK.,Department of Cardiovascular Medicine, King's College Hospital, London, UK
| | - Theresa McDonagh
- Cardiovascular Division, King's College Hospital London, British Heart Foundation Centre of Research Excellence, London, UK.,Department of Cardiovascular Medicine, King's College Hospital, London, UK
| | - Darlington O Okonko
- Cardiovascular Division, King's College Hospital London, British Heart Foundation Centre of Research Excellence, London, UK.,Department of Cardiovascular Medicine, King's College Hospital, London, UK
| | - Salma Ayis
- Department of Primary Care and Public Health Sciences, King's College London, London, UK
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13
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Khaira KB, Brinza E, Singh GD, Amsterdam EA, Waldo SW, Tong K, Pandya K, Laird JR, Armstrong EJ. Long-term outcomes in patients with critical limb ischemia and heart failure with preserved or reduced ejection fraction. Vasc Med 2017; 22:307-315. [DOI: 10.1177/1358863x17714153] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The impact of heart failure (HF) on long-term survival in patients with critical limb ischemia (CLI) has not been well described. Outcomes stratified by left ventricular ejection fraction (EF) are also unknown. A single center retrospective chart review was performed for patients who underwent treatment for CLI from 2006 to 2013. Baseline demographics, procedural data and outcomes were analyzed. HF diagnosis was based on appropriate signs and symptoms as well as results of non-invasive testing. Among 381 CLI patients, 120 (31%) had a history of HF and 261 (69%) had no history of heart failure (no-HF). Within the HF group, 74 (62%) had HF with preserved ejection fraction (HFpEF) and 46 (38%) had HF with reduced ejection fraction (HFrEF). The average EF for those with no-HF, HFpEF and HFrEF were 59±13% vs 56±9% vs 30±9%, respectively. The likelihood of having concomitant coronary artery disease (CAD) was lowest in the no-HF group (43%), higher in the HFpEF group (70%) and highest in the HFrEF group (83%) ( p=0.001). Five-year survival was on average twofold higher in the no-HF group (43%) compared to both the HFpEF (19%, p=0.001) and HFrEF groups (24%, p=0.001). Long-term survival rates did not differ between the two HF groups ( p=0.50). There was no difference in 5-year freedom from major amputation or freedom from major adverse limb events between the no-HF, HFpEF and HFrEF groups, respectively. Overall, the combination of CLI and HF is associated with poor 5-year survival, independent of the degree of left ventricular systolic dysfunction.
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Affiliation(s)
- Kavita B Khaira
- Vascular Center and Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - Ellen Brinza
- Division of Cardiology and VA Eastern Colorado Healthcare System, University of Colorado, Denver, CO, USA
| | - Gagan D Singh
- Vascular Center and Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - Ezra A Amsterdam
- Vascular Center and Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - Stephen W Waldo
- Division of Cardiology and VA Eastern Colorado Healthcare System, University of Colorado, Denver, CO, USA
| | - Kathleen Tong
- Vascular Center and Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - Kruti Pandya
- Vascular Center and Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - John R Laird
- Vascular Center and Division of Cardiovascular Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA, USA
| | - Ehrin J Armstrong
- Division of Cardiology and VA Eastern Colorado Healthcare System, University of Colorado, Denver, CO, USA
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