ArticleJACC. Basic to translational science2023
Fallacies of Using the Win Ratio in Cardiovascular Trials: Challenges and Solutions.
Article in JACC. Basic to translational science, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers.
What it found
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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.
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Who cites it
25 citing papers in PubMed.
- Trial
- Evaluating intensive blood pressure control versus usual care on cardiovascular disease in patients with diabetes using win statistics: a subgroup analysis of a cluster randomized trial.Journal of advanced research · 2026Trial
- Rationale and Design of CARDIO-TTRansform, a Phase 3 Trial of Eplontersen in Transthyretin Amyloid Cardiomyopathy.Circulation. Heart failure · 2026Trial
- Effects of anticoagulation in patients with device-detected atrial fibrillation and multiple stroke risk factors: a win ratio analysis of the NOAH-AFNET 6 trial.European heart journal. Quality of care & clinical outcomes · 2025Trial
- A hierarchical kidney outcome using win statistics in patients with heart failure from the DAPA-HF and DELIVER trials.Nature medicine · 2024Trial
- Methods for analyzing recurrent and terminal events considering composite and competing endpoints in clinical trials: a practical overview.BMC medical research methodology · 2026Review
- Pulmonary hypertension associated with interstitial lung disease: a state-of-the-art review.The European respiratory journal · 2026Review
- Randomized Clinical Trials Using a Hierarchical Composite Primary End Point: A Scoping Review.JAMA network open · 2026Article
- Confidence interval estimation for the win probability in cluster randomized trials with hierarchical composite endpoints using win fractions.Clinical trials (London, England) · 2026Article
- Empirical Comparison of Win Ratio and Joint Frailty Models for Recurrent Event Endpoints With Applications in Oncology and Cardiology.Statistics in medicine · 2026Article
- Covariate Adjustment for the Win Odds: Application to Cardiovascular Outcomes Trials.Statistics in medicine · 2026Article
- Article
- Comparison of primary analysis strategies of randomized controlled trials with multiple endpoints with application to kidney transplantation.Scientific reports · 2026Article
- A patient-centric paradigm and tool for clinical research: the DOOR is open.Antimicrobial agents and chemotherapy · 2026Article
- Win Ratio in Biomedical Science: A Bibliometric Analysis.CJC open · 2025Review
- Efficient statistical analysis of trial designs: win ratio and related approaches for composite outcomes.Perioperative medicine (London, England) · 2025Review
- Hierarchical Analysis of Composite Time-to-Event End Points in Heart Failure Clinical Trials Using Time in Clinical State.Circulation. Heart failure · 2025Review
- Derisking Phase II Clinical Trials in Heart Failure: A Position Paper from JACC: Basic to Translational Science and the Heart Failure Collaboratory.JACC. Basic to translational science · 2025Article
- Review
- The Win Ratio Approach in Bayesian Monitoring for Two-Arm Phase II Clinical Trial Designs With Multiple Time-To-Event Endpoints.Statistics in medicine · 2024Article
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The win ratio was introduced into cardiovascular trials as a potentially better way of analyzing composite endpoints to account for the hierarchy of clinical significance of their components and to facilitate the inclusion of recurrent events. The basic concept of the win ratio is to define a hierarchy of clinical importance within the components of the composite outcome, form all possible pairs by comparing every subject in the treatment group with every subject in the control group, and then evaluate each pair for the occurrence of the components of the composite outcome in descending order of importance, starting at the most important and progressing down the hierarchy if the outcome does not result in a win in either pair until pairs are tied for the outcome after exhaustion of all components. Although the win ratio offers a novel method of depiction of outcomes in clinical trials, its advantages may be counterbalanced by several fallacies (such as ignoring ties and weighting each hierarchal component equally) and challenges in appropriate clinical interpretation (establishing clinical meaningfulness of the observed effect size). From this perspective, we discuss these and other fallacies and provide a suggested framework to overcome such limitations to enhance utility of this statistical method across the clinical trial enterprise.
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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.