Limitations of analyses of effectiveness using observational data
| Autor: | Barnaby C Reeves |
|---|---|
| Rok vydání: | 2006 |
| Předmět: |
medicine.medical_specialty
business.industry medicine.medical_treatment Psychological intervention Revascularization medicine.disease law.invention Angina Quality of life Randomized controlled trial Bypass surgery law Cohort Physical therapy Medicine Observational study Cardiology and Cardiovascular Medicine business |
| Zdroj: | European Heart Journal. 27:1642-1643 |
| ISSN: | 1522-9645 0195-668X |
| Popis: | Graham and colleagues report health-related quality of life (HRQoL) in a cohort of patients 1 and 3 years after undergoing cardiac catheterization.1 The paper focuses on differences in HRQoL between groups of elderly patients (all >70 years of age) who were subsequently revascularized and those who received medication only. The former had consistently better HRQoL at both times, with a tendency for patients who had bypass surgery to report better health than those who had percutaneous intervention. The paper contributes to the growing literature suggesting that coronary revascularization is under-used,2–4 although it remains uncertain whether under-use arises because revascularization is withheld or refused. Increasing priority is being placed on estimating the effectiveness of interventions using outcomes that directly reflect patients' perceptions of the value of treatment (i.e. the extent to which benefits exceed harms), especially for interventions designed primarily to reduce the symptoms and physical impairments associated with chronic disease. Physicians are often suspicious about HRQoL, which they may perceive to be ‘soft’ or subjective. This suspicion is not warranted when properly validated instruments such as the Seattle Angina Questionnaire (and, more recently, the Coronary Revascularization Outcome Questionnaire),5 are used in participant-blinded randomized controlled trials (RCTs), where the interpretation of differences between groups is straightforward. Rather, physicians should see these instruments as measuring directly aspects of patients' lives, which they aim to influence by their clinical management. Interpretation of differences in HRQoL is more complex in observational studies, such as Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH).1 The authors analysed … *Corresponding author. Tel: +44 117 928 3143; fax: +44 117 929 9737. E-mail address : barney.reeves{at}bristol.ac.uk |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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