Do observational studies using propensity score methods agree with randomized trials? A systematic comparison of studies on acute coronary syndromes
| Autor: | Vasileia Varvarigou, Mei Chung, Georgios D Kitsios, Radley C. Sheldrick, Haseeb Jafri, Jessica K. Paulus, Issa J Dahabreh, Thomas A Trikalinos, Jeremy A. Rassen |
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| Rok vydání: | 2012 |
| Předmět: |
medicine.medical_specialty
Acute coronary syndrome Randomization business.industry Confounding MEDLINE Reproducibility of Results medicine.disease law.invention Treatment Outcome Randomized controlled trial Risk Factors law Internal medicine Relative risk Propensity score matching medicine Humans Regression Analysis Observational study Acute Coronary Syndrome Propensity Score Cardiology and Cardiovascular Medicine business Randomized Controlled Trials as Topic |
| Zdroj: | European Heart Journal. 33:1893-1901 |
| ISSN: | 1522-9645 0195-668X |
| DOI: | 10.1093/eurheartj/ehs114 |
| Popis: | Aims Randomized controlled trials (RCTs) are the gold standard for assessing the efficacy of therapeutic interventions because randomization protects from biases inherent in observational studies. Propensity score (PS) methods, proposed as a potential solution to confounding of the treatment–outcome association, are widely used in observational studies of therapeutic interventions for acute coronary syndromes (ACS). We aimed to systematically assess agreement between observational studies using PS methods and RCTs on therapeutic interventions for ACS. Methods and results We searched for observational studies of interventions for ACS that used PS methods to estimate treatment effects on short- or long-term mortality. Using a standardized algorithm, we matched observational studies to RCTs based on patients’ characteristics, interventions, and outcomes (‘topics’), and we compared estimates of treatment effect between the two designs. When multiple observational studies or RCTs were identified for the same topic, we performed a meta-analysis and used the summary relative risk for comparisons. We matched 21 observational studies investigating 17 distinct clinical topics to 63 RCTs (median = 3 RCTs per observational study) for short-term (7 topics) and long-term (10 topics) mortality. Estimates from PS analyses differed statistically significantly from randomized evidence in two instances; however, observational studies reported more extreme beneficial treatment effects compared with RCTs in 13 of 17 instances ( P = 0.049). Sensitivity analyses limited to large RCTs, and using alternative meta-analysis models yielded similar results. Conclusion For the treatment of ACS, observational studies using PS methods produce treatment effect estimates that are of more extreme magnitude compared with those from RCTs, although the differences are rarely statistically significant. |
| Databáze: | OpenAIRE |
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