SynthesisEuropean heart journal2018
Association is not causation: treatment effects cannot be estimated from observational data in heart failure.
Synthesis in European heart journal, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
21 citing papers in PubMed, 2 syntheses or guidelines pooled it, 47 citations in OpenAlex.
- Comprehensive comparative effectiveness and safety of first-line antihypertensive drug classes: a systematic, multinational, large-scale analysis.Lancet (London, England) · 2019Pooled it
- Digoxin-mortality: randomized vs. observational comparison in the DIG trial.European heart journal · 2019Pooled it
- Lymphocyte-to-C-Reactive Protein (LCR) Ratio Is Not Accurate to Predict Severity and Mortality in Patients with COVID-19 Admitted to the ED.International journal of molecular sciences · 2023Article
- Compound Danshen Dripping Pill inhibits hypercholesterolemia/atherosclerosis-induced heart failure in ApoE and LDLR dual deficient miceActa pharmaceutica Sinica. B · 2023Article
- Digoxin use and outcomes after myocardial infarction in patients with atrial fibrillation.Basic & clinical pharmacology & toxicology · 2022Article
- Association between dosing and combination use of medications and outcomes in heart failure with reduced ejection fraction: data from the Swedish Heart Failure Registry.European journal of heart failure · 2022Article
- Risk of Major Bleeding With Potent Antiplatelet Agents After an Acute Coronary Event: A Comparison of Ticagrelor and Clopidogrel in 5116 Consecutive Patients in Clinical Practice.Journal of the American Heart Association · 2021Observational
- Healthcare quality and mortality among patients hospitalized for heart failure by hospital level in Beijing, China.ESC heart failure · 2021Article
- The Decline of the Experimental Paradigm During the COVID-19 Pandemic: A Template for the Future.The American journal of medicine · 2021Review
- Late gadolinium enhancement for re-worsening left ventricular ejection fraction in patients with dilated cardiomyopathy.ESC heart failure · 2021Article
- Medical treatment of octogenarians with chronic heart failure: data from CHECK-HF.Clinical research in cardiology : official journal of the German Cardiac Society · 2020Article
- Randomized Trials Versus Common Sense and Clinical Observation: JACC Review Topic of the Week.Journal of the American College of Cardiology · 2020Review
- Principles of Large-scale Evidence Generation and Evaluation across a Network of Databases (LEGEND).Journal of the American Medical Informatics Association : JAMIA · 2020Article
- Large-scale evidence generation and evaluation across a network of databases (LEGEND): assessing validity using hypertension as a case study.Journal of the American Medical Informatics Association : JAMIA · 2020Article
- Deciphering the DNA Methylome of Polycystic Ovary Syndrome.Molecular diagnosis & therapy · 2020Review
- The year in cardiology: heart failure.European heart journal · 2020Article
- Spironolactone use is associated with improved outcomes in heart failure with mid-range ejection fraction.ESC heart failure · 2020Article
- Article
- How Confident Are We about Observational Findings in Healthcare: A Benchmark Study.Harvard data science review · 2020Article
- Digitalis therapy is associated with higher comorbidities and poorer prognosis in patients undergoing ablation of atrial arrhythmias: data from the German Ablation Registry.Clinical research in cardiology : official journal of the German Cardiac Society · 2019Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 2 institutions in 1 country.
Funding
Abstract
Aims: Treatment 'effects' are often inferred from non-randomized and observational studies. These studies have inherent biases and limitations, which may make therapeutic inferences based on their results unreliable. We compared the conflicting findings of these studies to those of prospective randomized controlled trials (RCTs) in relation to pharmacological treatments for heart failure (HF). Methods and results: We searched Medline and Embase to identify studies of the association between non-randomized drug therapy and all-cause mortality in patients with HF until 31 December 2017. The treatments of interest were: angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, mineralocorticoid receptor antagonists (MRAs), statins, and digoxin. We compared the findings of these observational studies with those of relevant RCTs. We identified 92 publications, reporting 94 non-randomized studies, describing 158 estimates of the 'effect' of the six treatments of interest on all-cause mortality, i.e. some studies examined more than one treatment and/or HF phenotype. These six treatments had been tested in 25 RCTs. For example, two pivotal RCTs showed that MRAs reduced mortality in patients with HF with reduced ejection fraction. However, only one of 12 non-randomized studies found that MRAs were of benefit, with 10 finding a neutral effect, and one a harmful effect. Conclusion: This comprehensive comparison of studies of non-randomized data with the findings of RCTs in HF shows that it is not possible to make reliable therapeutic inferences from observational associations. While trials undoubtedly leave gaps in evidence and enrol selected participants, they clearly remain the best guide to the treatment of patients.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.