Evidence map›Paper›PMID 34641870›Full record

ReviewBMC medical informatics and decision making2021

An informatics consult approach for generating clinical evidence for treatment decisions.

Alvina G Lai, Wai Hoong Chang, Constantinos A Parisinos, Michail Katsoulis, Ruth M Blackburn, Anoop D Shah, Vincent Nguyen, Spiros Denaxas, George Davey Smith, Tom R Gaunt and 19 more

Open access · goldAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in BMC medical informatics and decision making, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
2.0field-weighted citation impact, top 12% of its field
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 26 citations in OpenAlex.

  1. Article
  2. Article
  3. Real-world learnings for digital health industryFuture healthcare journal · 2024
    Article
  4. Article
  5. Article
  6. Article
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  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

29 authors at 16 institutions in 4 countries.

Alvina G LaiInstitute of Health Informatics, University College London, London, UK. alvina.lai@ucl.ac.uk.ORCID 0000-0001-8960-8095
Wai Hoong ChangInstitute of Health Informatics, University College London, London, UK.
Constantinos A ParisinosInstitute of Health Informatics, University College London, London, UK.
Michail KatsoulisInstitute of Health Informatics, University College London, London, UK.
Ruth M BlackburnInstitute of Health Informatics, University College London, London, UK.
Anoop D ShahInstitute of Health Informatics, University College London, London, UK.
Vincent NguyenInstitute of Health Informatics, University College London, London, UK.
Spiros DenaxasInstitute of Health Informatics, University College London, London, UK.
George Davey SmithMedical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
Tom R GauntMedical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
Krishnarajah NirantharakumarHealth Data Research UK, London, UK.
Murray P CoxStatistics and Bioinformatics Group, School of Fundamental Sciences, Massey University, Palmerston North, New Zealand.
Donall FordePublic Health Wales, University Hospital of Wales, Cardiff, UK.
Folkert W AsselbergsInstitute of Health Informatics, University College London, London, UK.
Steve HarrisUniversity College London Hospitals NHS Trust, London, UK.
Sylvia RichardsonMedical Research Council Biostatistics Unit, University of Cambridge, Cambridge, UK.
Reecha SofatInstitute of Health Informatics, University College London, London, UK.
Richard J B DobsonInstitute of Health Informatics, University College London, London, UK.
Aroon HingoraniHealth Data Research UK, London, UK.
Riyaz PatelInstitute of Cardiovascular Science, University College London, London, UK.
Jonathan SternePopulation Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Amitava BanerjeeInstitute of Health Informatics, University College London, London, UK.
Alastair K DennistonHealth Data Research UK, London, UK.
Simon BallHealth Data Research UK, London, UK.
Neil J SebireUCL Great Ormond Street Institute of Child Health, London, UK.
Nigam H ShahDepartment of Medicine, School of Medicine, Stanford University, Stanford, CA, USA.
Graham R FosterBarts Liver Centre, Blizard Institute, Queen Mary University of London, London, UK.
Bryan WilliamsUniversity College London Hospitals NIHR Biomedical Research Centre, London, UK.
Harry HemingwayInstitute of Health Informatics, University College London, London, UK.
Health Data Research UK · GBUniversity College London · GBUniversity College London Hospitals NHS Foundation Trust · GBUniversity of Bristol · GBUniversity Hospitals Birmingham NHS Foundation Trust · GBBarts Health NHS Trust · GBGreat Ormond Street Hospital · GBKing's College London · GBMassey University · NZQueen Mary University of London · GBStanford University · USThe Alan Turing Institute · GBUCL Biomedical Research Centre · GBUniversity Hospital of Wales · GBUniversity of Cambridge · GBUtrecht University · NL

Funding

British Heart Foundation FS/14/76/30933British Heart Foundation FS/18/5/33319Medical Research Council G0902393Medical Research Council MC_PC_13041Medical Research Council MC_PC_18034Medical Research Council MC_PC_19005Medical Research Council MC_UU_00002/10Medical Research Council MC_UU_00011/1Medical Research Council MC_UU_00011/4Medical Research Council MR/K006584/1Medical Research Council MR/S003797/1Medical Research Council MR/S003878/1Medical Research Council MR/V033867/1Wellcome TrustWellcome Trust 204841/Z/16/Z
6 · The paper itself

Abstract

backgroundAn Informatics Consult has been proposed in which clinicians request novel evidence from large scale health data resources, tailored to the treatment of a specific patient. However, the availability of such consultations is lacking. We seek to provide an Informatics Consult for a situation where a treatment indication and contraindication coexist in the same patient, i.e., anti-coagulation use for stroke prevention in a patient with both atrial fibrillation (AF) and liver cirrhosis.

methodsWe examined four sources of evidence for the effect of warfarin on stroke risk or all-cause mortality from: (1) randomised controlled trials (RCTs), (2) meta-analysis of prior observational studies, (3) trial emulation (using population electronic health records (N = 3,854,710) and (4) genetic evidence (Mendelian randomisation). We developed prototype forms to request an Informatics Consult and return of results in electronic health record systems.

resultsWe found 0 RCT reports and 0 trials recruiting for patients with AF and cirrhosis. We found broad concordance across the three new sources of evidence we generated. Meta-analysis of prior observational studies showed that warfarin use was associated with lower stroke risk (hazard ratio [HR] = 0.71, CI 0.39-1.29). In a target trial emulation, warfarin was associated with lower all-cause mortality (HR = 0.61, CI 0.49-0.76) and ischaemic stroke (HR = 0.27, CI 0.08-0.91). Mendelian randomisation served as a drug target validation where we found that lower levels of vitamin K1 (warfarin is a vitamin K1 antagonist) are associated with lower stroke risk. A pilot survey with an independent sample of 34 clinicians revealed that 85% of clinicians found information on prognosis useful and that 79% thought that they should have access to the Informatics Consult as a service within their healthcare systems. We identified candidate steps for automation to scale evidence generation and to accelerate the return of results.

conclusionWe performed a proof-of-concept Informatics Consult for evidence generation, which may inform treatment decisions in situations where there is dearth of randomised trials. Patients are surprised to know that their clinicians are currently not able to learn in clinic from data on 'patients like me'. We identify the key challenges in offering such an Informatics Consult as a service.

Indexed as

Atrial FibrillationStrokeAnticoagulantsHumansInformaticsReferral and ConsultationTreatment OutcomeWarfarinAnticoagulantsWarfarin

Identifiers

PMID34641870
PMCPMC8506488
OpenAlexW3201751808

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

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.