Survival analyses in cardiovascular research, part II: statistical methods in challenging situations

Rosselló, Xavier; González‐Del‐Hoyo, Maribel

doi:10.1016/j.rec.2021.07.001

Cited by 26 publications

(32 citation statements)

References 55 publications

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“…The follow-up period for the clinical outcomes started at day 91 to allow timely fulfillment of the process performance measures to avoid immortal time bias. 26 Patients were followed from day 91 after discharge date (inpatients)/first appointment date (outpatients) until death, migration, or 365 days.…”

Section: Methodsmentioning

confidence: 99%

Evidence-Based Process Performance Measures and Clinical Outcomes in Patients With Incident Heart Failure With Reduced Ejection Fraction: A Danish Nationwide Cohort Study

Schjødt

Strömberg

DeVore

et al. 2022

Circ: Cardiovascular Quality and Outcomes

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Background: Data on the association between quality of heart failure (HF) care and outcomes among patients with incident HF are sparse. We examined the association between process performance measures and clinical outcomes in patients with incident HF with reduced ejection fraction. Methods: Patients with incident HF with reduced ejection fraction (n=10 966) between January 2008 and October 2015 were identified from the Danish HF Registry. Data from public registries were linked. Multivariable regression analyses were used to assess the association between 6 guideline-recommended HF care processes (New York Heart Association assessment, use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, beta-blockers, and mineralocorticoid receptor antagonists, exercise training, and patient education) and all-cause and HF readmission, all-cause and HF hospital days, and mortality within 3 to 12 months after HF diagnosis. The associations were analyzed according to the percentages of all relevant performance measures fulfilled for the individual patient (0%–50% [reference group], >50%–75%, and >75%–100%) and for the individual performance measures. Results: Fulfilling >75% to 100% of the performance measures (n=5341 [48.7%]) was associated with lower risk of all-cause readmission (adjusted hazard ratio, 0.78 [95% CI, 0.68–0.89]) and HF readmission (adjusted hazard ratio, 0.71 [95% CI, 0.54–0.92]), lower use of all-cause hospital days (adjusted mean ratio, 0.73 [95% CI, 0.70–0.76]) and HF hospital days (adjusted mean ratio, 0.79 [95% CI, 0.70–0.89]), and lower mortality (adjusted hazard ratio, 0.42 [95% CI, 0.32–0.53]). A dose-response relationship was observed between fulfilling more performance measures and mortality (adjusted hazard ratio, 0.62 [95% CI, 0.49–0.77] fulfilling >50%–75% of the measures). Fulfilling individual performance measures, except mineralocorticoid receptor antagonist therapy, was associated with lower adjusted all-cause readmission, lower adjusted use of all-cause and HF hospital days, and lower adjusted mortality. Conclusions: Fulfilling more process performance measures was associated with better clinical outcomes in patients with incident HF with reduced ejection fraction.

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Section: Methodsmentioning

confidence: 99%

Evidence-Based Process Performance Measures and Clinical Outcomes in Patients With Incident Heart Failure With Reduced Ejection Fraction: A Danish Nationwide Cohort Study

Schjødt

Strömberg

DeVore

et al. 2022

Circ: Cardiovascular Quality and Outcomes

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“…The stratified Cox proportional hazard models were used because the baseline risk and hazards in each cohort constituting the HOMAGE cohort were different and unrelated. 16 Age, systolic blood pressure (SBP) and estimated glomerular filtration rate (eGFR) were categorized due to non-linearity. A backward selection procedure was applied to determine the variables to be included in the multivariable models.…”

Section: Discussionmentioning

confidence: 99%

“…Due to differences in duration of follow‐up between each cohort, the cohorts were added as strata in the Cox regression models for the HOMAGE database. The stratified Cox proportional hazard models were used because the baseline risk and hazards in each cohort constituting the HOMAGE cohort were different and unrelated 16 . Age, systolic blood pressure (SBP) and estimated glomerular filtration rate (eGFR) were categorized due to non‐linearity.…”

Section: Methodsmentioning

confidence: 99%

Comparing and contrasting risk factors for heart failure in patients with and without history of myocardial infarction: data from HOMAGE and the UK Biobank

Rastogi

Rossignol

et al. 2022

European J of Heart Fail

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“…The scientific validity of the study is limited by the sample size and the inherent failure to correct for unknown additional confounders. Second, all-cause mortality was a competing risk for recurrent myocardial infarction in our study [ 19 , 20 ], and to some extent affects the evaluation of the utility of beta-blockers for recurrent myocardial infarction; future studies need to take this issue of competing risks into account. Third, our study is a retrospective study and it is difficult to obtain information about the use of beta-blockers over the entire follow-up period in patients with AMI.…”

Section: Discussionmentioning

confidence: 99%

Short-term/long-term prognosis with or without beta-blockers in patients without heart failure and with preserved ejection fraction after acute myocardial infarction: a multicenter retrospective cohort study

Wen

Luo

Liu

et al. 2022

BMC Cardiovasc Disord

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Background The role of beta-blockers in acute myocardial infarction patients without heart failure and with preserved left ventricular ejection fraction (LVEF ≥ 50%) is unknown. Our study aimed to retrospectively analyze the associations of beta-blockers on such patients. Methods This is a multicenter, retrospective study. After screening 5,332 acute myocardial infarction patients, a total of 2519 patients without heart failure and with LVEF ≥ 50% were included. The patients were divided into two groups: the prescribed (n = 2049) and unprescribed (n = 470) beta-blockers group. The propensity score inverse probability treatment weighting was used to control confounding factors. We analyzed the associations between beta-blockers and outcomes in the short-term (1-year) and long-term (median, 3.61 years). Results The primary outcome was all-cause mortality. The secondary outcomes were all-cause rehospitalization, cardiac death, recurrent myocardial infarction, new-onset heart failure rehospitalization. This study shows no statistically significant association between discharged with beta-blockers and all-cause mortality, either in the short-term [IPTW Adjusted, HR 1.02; 95%CI 0.43–2.40; P = 0.966] or long-term [IPTW Adjusted, HR 1.17; 95%CI 0.70–1.94; P = 0.547]. Discharged with beta-blockers was significantly associated with a reduced risk of short-term recurrent myocardial infarction [IPTW Adjusted, HR 0.44; 95%CI 0.20–0.97; P = 0.043], but there was no long-term relationship [IPTW Adjusted, HR 1.11; 95%CI 0.61–2.03; P = 0.735]. Other outcomes, such as new-onset heart failure rehospitalization and all-cause rehospitalization, were not observed with meaningful differences in either the short- or long-term. The results of sensitivity analysis were consistent with this. Conclusions Beta-blockers might be associated with a reduced risk of recurrent myocardial infarction in patients without heart failure and with preserved left ventricular ejection fraction after acute myocardial infarction, in the short term. Beta-blockers might not be related to all-cause mortality in those patients, either in the short-term or long-term. Clinical trial registration Influence of Beta-blockers on Prognosis in Patients with Acute Myocardial Infarction Complicated with Normal Ejection Fraction, NCT04485988, Registered on 24/07/2020. Retrospectively registered.

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Survival analyses in cardiovascular research, part II: statistical methods in challenging situations

Cited by 26 publications

References 55 publications

Evidence-Based Process Performance Measures and Clinical Outcomes in Patients With Incident Heart Failure With Reduced Ejection Fraction: A Danish Nationwide Cohort Study

Evidence-Based Process Performance Measures and Clinical Outcomes in Patients With Incident Heart Failure With Reduced Ejection Fraction: A Danish Nationwide Cohort Study

Comparing and contrasting risk factors for heart failure in patients with and without history of myocardial infarction: data from HOMAGE and the UK Biobank

Short-term/long-term prognosis with or without beta-blockers in patients without heart failure and with preserved ejection fraction after acute myocardial infarction: a multicenter retrospective cohort study

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