Patient engagement in a trial testing a new strategy of care for acute heart failure

Lee, Douglas S.; Armstrong, R. B.; Mohamed, Shanas

doi:10.1503/cmaj.180462

CMAJ

2018

DOI: 10.1503/cmaj.180462

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Patient engagement in a trial testing a new strategy of care for acute heart failure

Douglas S. Lee

R. B. Armstrong

Shanas Mohamed

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Cited by 5 publications

(1 citation statement)

References 7 publications

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“… 10 , 11 These outcomes may have different degrees of importance to subspecialist physicians (eg, heart failure specialists, cardiac electrophysiologists, interventional cardiologists, cardiac surgeons), generalists, and hospitalists. Based on our prior work engaging patients, 12 , 13 the outcomes that are important to patients extend beyond all-cause mortality. This reinforces the importance of being able to provide accurate estimates of the absolute risk of multiple outcomes, as these are easier for patients to understand and enable appropriate patient decision making.…”

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confidence: 99%

Estimation of the Absolute Risk of Cardiovascular Disease and Other Events: Issues With the Use of Multiple Fine-Gray Subdistribution Hazard Models

Austin

Putter

Lee

et al. 2022

Circ: Cardiovascular Quality and Outcomes

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Background: The Fine-Gray subdistribution hazard model is frequently used in the cardiovascular literature to estimate subject-specific probabilities of the occurrence of an event of interest over time in the presence of competing risks. A little-known limitation of this approach is that, for some subjects and for some time points, the sum of the subject-specific probabilities for the different event types (eg, cardiovascular and noncardiovascular death) can exceed one. Methods: We used data on 8238 patients hospitalized with congestive heart failure in Ontario, Canada. We fit 2 Fine-Gray subdistribution hazards models, one for cardiovascular death and one for noncardiovascular death and estimated the probability of death due to each cause within 5 years of hospital admission. We also fit 2 cause-specific hazard models for the 2 event types and combined the estimated cause-specific hazard functions to obtain subject-specific estimates of the probabilities of each of the 2 event types occurring within 5 years. Results: When adding the probabilities of 5-year cardiovascular death and 5-year noncardiovascular death obtained from the Fine-Gray subdistribution hazard models, 8.6% of subjects had an estimated probability of 5-year all-cause mortality that exceeded 1 (100%). This problem was avoided by fitting 2 cause-specific hazard models, one for each outcome type, and combining the estimated cause-specific hazard functions to obtain subject-specific estimates of the risk of cardiovascular and noncardiovascular death. Conclusions: The Fine-Gray subdistribution hazard model may be problematic to use for a comprehensive assessment of absolute risks of multiple outcomes, while the combination of 2 cause-specific hazard models shows better statistical behaviour. Cause-specific modeling should not be discarded in competing risk situations.

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confidence: 99%

Estimation of the Absolute Risk of Cardiovascular Disease and Other Events: Issues With the Use of Multiple Fine-Gray Subdistribution Hazard Models

Austin

Putter

Lee

et al. 2022

Circ: Cardiovascular Quality and Outcomes

Self Cite

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Rationale and design of the comparison of outcomes and access to care for heart failure (COACH) trial: A stepped wedge cluster randomized trial

Lee

Straus

Austin

et al. 2021

American Heart Journal

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Analysis of How Emergency Physicians’ Decisions to Hospitalize or Discharge Patients With Acute Heart Failure Match the Clinical Risk Categories of the MEESSI-AHF Scale

Miró¹,

Rosselló²,

Gil³

et al. 2019

Annals of Emergency Medicine

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Patient engagement in a trial testing a new strategy of care for acute heart failure

Cited by 5 publications

References 7 publications

Estimation of the Absolute Risk of Cardiovascular Disease and Other Events: Issues With the Use of Multiple Fine-Gray Subdistribution Hazard Models

Estimation of the Absolute Risk of Cardiovascular Disease and Other Events: Issues With the Use of Multiple Fine-Gray Subdistribution Hazard Models

Rationale and design of the comparison of outcomes and access to care for heart failure (COACH) trial: A stepped wedge cluster randomized trial

Analysis of How Emergency Physicians’ Decisions to Hospitalize or Discharge Patients With Acute Heart Failure Match the Clinical Risk Categories of the MEESSI-AHF Scale

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