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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
#ESCCongress Day2 stirred up discussion
Suggest 👀 following 1-4
Tweetorials, articles, slides, guidelines
@escardio @ESC_Journals @Steph_Achenbach @EuroInterventio #EAPCI @PCRonline
1
Tweetorials
@rwyeh Validation of Scores
@AnilMakam #SCOTHeart
@venkmurthy #ADVANCE CT-FFR
Suggest 👀 following 1-4
Tweetorials, articles, slides, guidelines
@escardio @ESC_Journals @Steph_Achenbach @EuroInterventio #EAPCI @PCRonline
1
Tweetorials
@rwyeh Validation of Scores
@AnilMakam #SCOTHeart
@venkmurthy #ADVANCE CT-FFR
#ESCCongress 👀 2
Articles
#ASCEND nejm.org/doi/full/10.10…
#SCOTHeart nejm.org/doi/full/10.10…
#DAPTSCORE Validation acc.org/latest-in-card…
#ARRIVE hubs.ly/H0dxDh50
#Burnout kevinmd.com/blog/2018/03/b…
Articles
#ASCEND nejm.org/doi/full/10.10…
#SCOTHeart nejm.org/doi/full/10.10…
#DAPTSCORE Validation acc.org/latest-in-card…
#ARRIVE hubs.ly/H0dxDh50
#Burnout kevinmd.com/blog/2018/03/b…
#ESCCongress 👀3
SlidesShare via @CMichaelGibson
Part 1
#CulpritShock clinicaltrialresults.org/Slides/ESC2018…
#Matrix clinicaltrialresults.org/Slides/ESC2018…
#FUTURE clinicaltrialresults.org/Slides/ESC2018…
#FRANCETAVI clinicaltrialresults.org/Slides/ESC2018…
#COMPASS clinicaltrialresults.org/Slides/ESC2018…
SlidesShare via @CMichaelGibson
Part 1
#CulpritShock clinicaltrialresults.org/Slides/ESC2018…
#Matrix clinicaltrialresults.org/Slides/ESC2018…
#FUTURE clinicaltrialresults.org/Slides/ESC2018…
#FRANCETAVI clinicaltrialresults.org/Slides/ESC2018…
#COMPASS clinicaltrialresults.org/Slides/ESC2018…
1| follow for my critical appraisal tweetorial of #SCOTHEART trial in @NEJM #ESCCongress
Basics: RCT of upfront CTA vs standard of care for stable CP referred to Scottish cardiology clinics. 1.6% fewer had primary outcome with CTA
nejm.org/doi/full/10.10…
Basics: RCT of upfront CTA vs standard of care for stable CP referred to Scottish cardiology clinics. 1.6% fewer had primary outcome with CTA
nejm.org/doi/full/10.10…
2| more basics: primary outcome is driven by nonfatal MI, not death. Authors did tremendous job at highlighting this
#ESCCongress #SCOTHEART
#ESCCongress #SCOTHEART
3| before diving in to methods/findings, how would a CTA first approach meaningfully change outcomes?
#ESCCongress
#ESCCongress
