In-Hospital and Post-Discharge Treatment Regimens of Cardiac Patients Should Be Reported for a More Accurate Treatment Selection Bias Assessment in Prognostic Studies
Journal of Practical Emergency Medicine,
Vol. 10 No. 1 (2023),
1 January 2023
,
Page e12
https://doi.org/10.22037/jpem.v10i1.42237
Abstract
Cardiovascular diseases are one of the most important causes of death worldwide, resulting in a burden of 423 million DALYs and 21 million deaths in 2021. Extensive research is being conducted in numerous fields of cardiovascular disease, and observational studies have become a significant body of related literature. One of the main purposes of observational studies is the evaluation of the diagnostic and prognostic capabilities of index tests, scoring tools, and other clinical and paraclinical factors.
Quality Assessment of Prognostic Accuracy Studies (QUAPAS) guidelines have been recently introduced as an alternative to Quality Assessment of Diagnostic Accuracy Studies (QUADAS) guidelines for appraisal of the risk of bias in prognostic studies. QUAPAS guidelines propose treatment regimen differences between patients as a source of bias in the flow and timing domain.
According to these guidelines, “Clinical management should ideally be identical for all study participants during the follow-up period”; otherwise, the study results will likely contain bias. In our previous systematic reviews, most articles had not specified their patient treatment regimens. The differences in treatment strategies between patients and between studies can affect the study results and influence the calculated prognostic or diagnostic value of a possible index test. Thus, these studies are evaluated as having some concerns regarding their risk of bias. Observational studies, especially diagnostic and prognostic accuracy studies, should report the patient’s treatment regimens to address this issue.
Since it is often impossible to equate the treatments of cardiovascular patients due to their different assessed risks, the studies should utilize multivariate analysis models to adjust for the treatment regimen variations and report their results as adjusted odds ratio, adjusted relative risk, or adjusted hazard ratio. Prognostic studies are also subject to time-event outcomes and need to account for censoring. Therefore, we suggest these studies implement cox regression models in their analyses.
- Acute Myocardial Infarction
- Cardiac
- Reporting
- Bias
How to Cite
References
Vaduganathan M, Mensah GA, Turco JV, Fuster V, Roth GA. The Global Burden of Cardiovascular Diseases and Risk: A Compass for Future Health. J Am Coll Cardiol. 2022;80(25):2361-71.
Ramezani F, Ahmadi S, Faridaalee G, Baratloo A, Yousefifard M. Value of Manchester Acute Coronary Syndromes Decision Rule in the Detection of Acute Coronary Syndrome; a Systematic Review and Meta-Analysis. Emerg (Tehran). 2018;6(1):e61.
Ke J, Chen Y, Wang X, Wu Z, Chen F. Indirect comparison of TIMI, HEART and GRACE for predicting major cardiovascular events in patients admitted to the emergency department with acute chest pain: a systematic review and meta-analysis. BMJ Open. 2021;11(8):e048356.
Aghajani MH, Toloui A, Ahmadzadeh K, Neishaboori AM, Yousefifard M. Premature Coronary Artery Disease and Plasma Levels of Interleukins; a Systematic Scoping Review and Meta-Analysis. Archives of academic emergency medicine. 2022;10(1).
Lee J, Mulder F, Leeflang M, Wolff R, Whiting P, Bossuyt PM. QUAPAS: An Adaptation of the QUADAS-2 Tool to Assess Prognostic Accuracy Studies. Annals of Internal Medicine. 2022;175(7):1010-8.
Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Annals of internal medicine. 2011;155(8):529-36.
Baratloo A, Mohamadi M, Mohammadi M, Toloui A, Neishaboori AM, Alavi SNR, et al. The value of predictive instruments in the screening of acute stroke: an umbrella review on previous systematic reviews. Frontiers in Emergency Medicine. 2022.
Ahmadzadeh K, Hajebi A, Ramawad HA, Azizi Y, Yousefifard M. Value of N-Terminal Pro-Brain Natriuretic Peptide for Embolic Events Risk Prediction in Patients with Atrial Fibrillation; a Systematic Review and Meta-Analysis. Archives of Academic Emergency Medicine. 2023;11(1):e8-e.
Khari S, Zandi M, Zarmehrparirouy M, Ramawad HA, Yousefifard M. Prognostic Value of Physiological Scoring Systems in COVID-19 Patients: A Prospective Observational Study. Advanced Emergency Nursing Journal. 2023;45(1):77-85.
- Abstract Viewed: 252 times
- pdf Downloaded: 179 times
