Estimating the Lifetime Benefits of Treatments for Heart Failure
| Autor: | Pardeep S. Jhund, Stuart J. Pocock, Brian Claggett, Kieran F. Docherty, Faiez Zannad, John J.V. McMurray, Scott D. Solomon, John Gregson, João Pedro Ferreira, Susan Stienen, Mark C. Petrie |
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| Přispěvatelé: | Cardiology, ACS - Heart failure & arrhythmias, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], French-Clinical Research Infrastructure Network - F-CRIN [Paris] (Cardiovascular & Renal Clinical Trialists - CRCT ), Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences. Amsterdam University Medical Center, University of Amsterdam, Cardiovascular Division Brigham and Women's Hospital 75 Francis Street Boston, Brigham and Women's Hospital [Boston], Department of Biostatistics, London School of Hygiene and Tropical Medicine, JPF & FZ are supported by ANR-15-RHU-0004 and ANR-15-IDEX-04-LUE. JJM, PSJ, and MCP are supported by BHF Grant RE/18/6/34217., ANR-15-RHUS-0004,FIGHT-HF,Combattre l'insuffisance cardiaque(2015), ANR-15-IDEX-0004,LUE (ISITE),Lorraine Université d'Excellence(2016), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL) |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Spironolactone 030204 cardiovascular system & hematology Lower risk Placebo HF heart failure Sacubitril RMST restricted mean survival time 03 medical and health sciences 0302 clinical medicine [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system Mini-Focus: Clinical Trial Considerations Risk Factors Internal medicine Patient-Centered Care medicine Humans 030212 general & internal medicine NYHA New York Heart Association HFrEF heart failure with reduced ejection fraction Survival analysis Mineralocorticoid Receptor Antagonists Original Research Heart Failure survival models business.industry Hazard ratio Absolute risk reduction trials Infant Stroke Volume treatment effects HR hazard ratio Confidence interval Eplerenone 3. Good health CI confidence interval Survival Rate restricted mean survival time Research Design Relative risk NNT number needed to treat NT-proBNP N-terminal pro–B-type natriuretic peptide Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | JACC. Heart failure, 8(12), 984-995. Elsevier BV Jacc. Heart Failure JACC: Heart Failure JACC: Heart Failure, Elsevier/American College of Cardiology, 2020, 8 (12), pp.984-995. ⟨10.1016/j.jchf.2020.08.004⟩ |
| ISSN: | 2213-1779 |
| DOI: | 10.1016/j.jchf.2020.08.004⟩ |
| Popis: | Objectives This study compared ways of describing treatment effects. The objective was to better explain to clinicians and patients what they might expect from a given treatment, not only in terms of relative and absolute risk reduction, but also in projections of long-term survival. Background The restricted mean survival time (RMST) can be used to estimate of long-term survival, providing a complementary approach to more conventional metrics (e.g., absolute and relative risk), which may suggest greater benefits of therapy in high-risk patients compared with low-risk patients. Methods Relative and absolute risk, as well as the RMST, were calculated in heart failure with reduced ejection fraction (HFrEF) trials. Results As examples, in the RALES trial (more severe HFrEF), the treatment effect metrics for spironolactone versus placebo on heart failure hospitalization and/or cardiovascular death were a hazard ratio (HR) of 0.67 (95% confidence interval [CI]: 0.5 to 0.77), number needed to treat = 9 (7 to 14), and age extension of event-free survival +1.1 years (−0.1 to + 2.3 years). The corresponding metrics for EMPHASIS-HF (eplerenone vs. placebo in less severe HFrEF) were 0.64 (0.54 to 0.75), 14 (1 to 22), and +2.9 (1.2 to 4.5). In patients in PARADIGM-HF aged younger than 65 years, the metrics for sacubitril/valsartan versus enalapril were 0.77 (95% CI: 0.68 to 0.88), 23 (15 to 44), and +1.7 (0.6 to 2.8) years; for those aged 65 years or older, the metrics were 0.83 (95% CI: 0.73 to 0.94), 29 (17 to 83), and +0.9 (0.2 to 1.6) years, which provided evidence of a greater potential life extension in younger patients. Similar observations were found for lower risk patients. Conclusions RMST event-free (and overall) survival estimates provided a complementary means of evaluating the effect of therapy in relation to age and risk. They also provided a clinically useful metric that should be routinely reported and used to explain the potential long-term benefits of a given treatment, especially to younger and less symptomatic patients. Central Illustration |
| Databáze: | OpenAIRE |
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