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By @rwyeh request, I bring you this brief introduction of joint frailty models and their application in the #COAPT trial...
By @rwyeh request, I bring you this brief introduction of joint frailty models and their application in the #COAPT trial...
Please be advised that @graemeleehickey and others are more expert than I am in the direct, real-world application of such models, but here I am, so whatever. Read it, or don’t.
Suppose you’re just reading along in the #COAPT primary paper, found here:
nejm.org/doi/full/10.10…
when you encounter this bumfuzzle:
nejm.org/doi/full/10.10…
when you encounter this bumfuzzle:
1/ A long thread on LifeVest. I promise it will be entertaining. If you find any inaccuracies please let me know.
Paper of VEST published here - will discuss background to WCD and #VEST but not the trial itself nejm.org/doi/full/10.10…
Paper of VEST published here - will discuss background to WCD and #VEST but not the trial itself nejm.org/doi/full/10.10…
2/ In 2001, FDA gave approval to Lifecor for the first WCD. Later Lifecor was acquired by Zoll (2004 agreement, 2006 acquisition). Zoll maintains a registry for prescribed LifeVests. But lets go back to the FDA approval process.
3/ Lifecor presented 2 separate prospective studies to the FDA; WEARIT and BIROAD. FDA asked for both to be combined into 1 study, and each study representing a subgroup. A total of 289 patients were included.
Now that the #epibookclub is over, my weekends are free for reading #RCTs. So, how about a #tweetorial about #pragmatic trials, causal questions, and #landmark analyses, inspired by the #SCOTHEART trial?
#epimethodsclub #cardiotwitter
#epimethodsclub #cardiotwitter
If we’re going to talk about #pragmatic trials, then we need to start with a definition. The simplest definition I’ve seen is from a trialist I interviewed for my recent @JClinEpi paper (authors.elsevier.com/a/1XS1b3BcJPuv…)
pRCTs “...attempt to address effectiveness in real world settings”
pRCTs “...attempt to address effectiveness in real world settings”
Sure, it’s a bit vague but it’s useful because, like Tolstoy’s unhappy families, #pragmatic trials are all different.
So, what makes me think #SCOTHEART is pragmatic?
My 2¢: lack of blinding, inclusion criteria based on symptoms not diagnoses, & standard care as comparator.
So, what makes me think #SCOTHEART is pragmatic?
My 2¢: lack of blinding, inclusion criteria based on symptoms not diagnoses, & standard care as comparator.
1| Good #cardiotwitter on #SCOTHeart. Others have tweeted reasons y believable. Here is my reply tweetorial
@khurramn1 @AChoiHeart @MarcDweck @JWeirMcCall @rwyeh @drjohnm @venkmurthy @DavidLBrownMD @RogueRad
#ESCCongress
Linking my original tweetorial:
@khurramn1 @AChoiHeart @MarcDweck @JWeirMcCall @rwyeh @drjohnm @venkmurthy @DavidLBrownMD @RogueRad
#ESCCongress
Linking my original tweetorial:
2| Let's start with MI def. Billing codes less accurate than adjudicated MI outcomes, yes? Could be nondiff misclassification which bias to null. But could also be diff w/ ascertainment bias (look harder, anchoring) knowing CCTA result, since 2/3rds normal or nonobstruct.
3| It is conjecture. But basis of clinical reasoning is to factor in test results. The posterior probability for this theory moves up much higher when we try to figure out by what mechanism did a diagnostic testing strategy lead to better outcomes, since the radiation did zilch
1/
As #ESCCongress nears, I thought I would do a #tweetorial on amyloidosis. Exciting times for the field and new data/treatments expected next week.
#FITSurvivalGuide #CardioTwitter @tony_breu @rodney_falk @marthagrogan1 @amyloidosisfdn @AmyloidosisSupp @Amyloidosis_ARC
As #ESCCongress nears, I thought I would do a #tweetorial on amyloidosis. Exciting times for the field and new data/treatments expected next week.
#FITSurvivalGuide #CardioTwitter @tony_breu @rodney_falk @marthagrogan1 @amyloidosisfdn @AmyloidosisSupp @Amyloidosis_ARC
2/
What is amyloidosis?
A protein misfolding disorder in which one of thirty-five distinct proteins pathologically misfolds and aggregates extracellularly as insoluble amyloid fibrils, ultimately leading to organ dysfunction.
What is amyloidosis?
A protein misfolding disorder in which one of thirty-five distinct proteins pathologically misfolds and aggregates extracellularly as insoluble amyloid fibrils, ultimately leading to organ dysfunction.
3/
You can see that other diseases like Alzheimer’s involve amyloid deposition. We will focus on two types of amyloidosis that affect the heart and nervous system: immunoglobulin light chain (AL) and transthyretin (ATTR) amyloidosis.
You can see that other diseases like Alzheimer’s involve amyloid deposition. We will focus on two types of amyloidosis that affect the heart and nervous system: immunoglobulin light chain (AL) and transthyretin (ATTR) amyloidosis.
Evaluation of Cardiac Masses:
A Tweetorial for #FITSurvivalGuide 🚨 #ACCImaging @ASE360 @SCMR @journalofCMR @ACCinTouch
Dedicated:@dr_chirumamilla & all #ACCFIT in #CardioTwitter
Main Ref: link.springer.com/article/10.100… Palaskas, et al. Curr Treat Options Cardio Med (2018) 20: 29.
A Tweetorial for #FITSurvivalGuide 🚨 #ACCImaging @ASE360 @SCMR @journalofCMR @ACCinTouch
Dedicated:@dr_chirumamilla & all #ACCFIT in #CardioTwitter
Main Ref: link.springer.com/article/10.100… Palaskas, et al. Curr Treat Options Cardio Med (2018) 20: 29.
Usually, it all starts with an abnormal finding in an echo suggestive of intracavitary mass. How can we tell one from the other? It can be confusing.
For artifacts, I did a Tweetorial already that describes the most common ones. Basic understanding of ultrasound physics is needed to be able to explain them: twitter.com/i/moments/1030…
1/10 “To PCI, or Not to PCI, That is the Question” Will Shakespeare, MD
#FITSurvivalGuide
*Per many contentious #cardiotwitter discussions I realize this is loaded topic but I’m going to attempt an early stage #ACCFIT overview while recognizing there is a lot of nuance.
#FITSurvivalGuide
*Per many contentious #cardiotwitter discussions I realize this is loaded topic but I’m going to attempt an early stage #ACCFIT overview while recognizing there is a lot of nuance.
2/10 Why not “See lesion Fix lesion”?
Poor correlation between est'd visual stenosis & quantitative stenosis. And, without noninvasive ischemic data, coronary angio has limited accuracy w/ regard to identifying significance of many stenoses
*STEMI PCI already done @KhandelwalMD
Poor correlation between est'd visual stenosis & quantitative stenosis. And, without noninvasive ischemic data, coronary angio has limited accuracy w/ regard to identifying significance of many stenoses
*STEMI PCI already done @KhandelwalMD
3/10 COURAGE trial (OMT vs OMT and PCI of visually-estimated significant stenoses): No difference death/MI between OMT & OMT/PCI. PCI demonstrated clinical benefit only when treating relevant myocardial ischemia determined by noninvasive testing.
This is DEEPLY CONCERNING editorial behavior... and
I think its time we start talking about the Use, Misuse and Abuse of Academic Power. [THREAD] #cardiotwitter medscape.com/viewarticle/89…
I think its time we start talking about the Use, Misuse and Abuse of Academic Power. [THREAD] #cardiotwitter medscape.com/viewarticle/89…
First, the ISCHEMIA trial is clearly ruffling feathers since the primary endpoint was changed. It is a costly 100mi buck FEDERAL funded trial, and it just switched from a bias resistant to a bias prone endpoint
That's a big deal
That's a big deal
I read the article by Murthy and Eagle in FULL
I found it to be a lucid, stellar commentary about the deep and fundamental problems with the trial.
It was a SLEDGEHAMMER of clear thinking & reason
& it was persuasive
perhaps that was the problem
I found it to be a lucid, stellar commentary about the deep and fundamental problems with the trial.
It was a SLEDGEHAMMER of clear thinking & reason
& it was persuasive
perhaps that was the problem
Risk Ratio, Odds Ratio, Hazard Ratio
========================
2nd and final part of the tweetorial, from ORBITA-HQ!
Fun, easy and informative [*]
#MedEd #FOAMed #cardiology #cardiotwitter
[*] Results may vary and are not guaranteed. See small print.
========================
2nd and final part of the tweetorial, from ORBITA-HQ!
Fun, easy and informative [*]
#MedEd #FOAMed #cardiology #cardiotwitter
[*] Results may vary and are not guaranteed. See small print.
Not all fears are alike.
* Some fears are one-and-done:
I get a cold which progresses to pneumonia. Will I die, or recover?
* Other things hang over us for much longer, perhaps all your life.
Will you get hit by a bus?
Get a heart attack?
There's no "sell by" date on the fear.
* Some fears are one-and-done:
I get a cold which progresses to pneumonia. Will I die, or recover?
* Other things hang over us for much longer, perhaps all your life.
Will you get hit by a bus?
Get a heart attack?
There's no "sell by" date on the fear.
Practice Qs
You are walking through Hyde park, minding your own business.
Hardly causing any trouble at all.
Perhaps the odd humorous tweet.
You get a Direct Message:
"Enough of ur abuse!
You will be hearing form my agent shortly.
kthxbai
AJ Kirtane"
You see the agent:
You are walking through Hyde park, minding your own business.
Hardly causing any trouble at all.
Perhaps the odd humorous tweet.
You get a Direct Message:
"Enough of ur abuse!
You will be hearing form my agent shortly.
kthxbai
AJ Kirtane"
You see the agent:
Going to attempt my first TWEETORIAL (h/t @ProfDFrancis, @venkmurthy, @VinayPrasad82 and others) about an innovative clinical trial & how it may be useful in making RCT’s pragmatic, fleet & adaptable
Some shiny objects to get everyone’s attention: Bayesian adaptive-enrichment design and how it might help resolve the #RCT4Impella controversy
Good folks of #cardiotwitter, I hope that #RCT4Impella will suck you in here… (@SVRaoMD , @thebyrdlab , @DavidLBrownMD , @willsuh76 for starters)
MYOCARDIAL VIABILITY
================
Lazarus revisited
[Tweetorial from ORBITA-hq: "Making cardiologists think again"(TM)]
Please retweet to cardiology fellows or anyone who might be interested to practice data interpretation.
================
Lazarus revisited
[Tweetorial from ORBITA-hq: "Making cardiologists think again"(TM)]
Please retweet to cardiology fellows or anyone who might be interested to practice data interpretation.
Let's start our story here, when I was first informed that viability testing saves lives.
A few weeks later, a decisive meta-analysis.
3000 patients
3000 patients
Considering #statin in 35-y-o man worried about extensive family history of MI+stroke: 2 parents, 3 of 4 sibs.
#Cholesterol 5.8 mM, 224 mg/dl. Subtypes typical for such a total.
Non-smoker. Otherwise average.
[Live-quiz from #orbita-HQ for #cardioTwitter fellows & the curious]
#Cholesterol 5.8 mM, 224 mg/dl. Subtypes typical for such a total.
Non-smoker. Otherwise average.
[Live-quiz from #orbita-HQ for #cardioTwitter fellows & the curious]
Question C2.
First vote was for diet first, and quite right too! That is the guideline, and we must obey.
Natural, organic, eco-friendly and therefore best.
What effect size is a reasonable expectation, for patient and Dr, for the reduction of total cholesterol by diet?
First vote was for diet first, and quite right too! That is the guideline, and we must obey.
Natural, organic, eco-friendly and therefore best.
What effect size is a reasonable expectation, for patient and Dr, for the reduction of total cholesterol by diet?
Question C3.
(currently 0.8 mmol/L in the lead for Question C2)
There are several ways to choose a value. Which did you use?
(currently 0.8 mmol/L in the lead for Question C2)
There are several ways to choose a value. Which did you use?
