Evidence map›Paper›PMID 38525596›Full record

ArticleCirculation. Cardiovascular quality and outcomes2024

Estimating Vitamin K Antagonist Anticoagulation Benefit in People With Atrial Fibrillation Accounting for Competing Risks: Evidence From 12 Randomized Trials.

Sachin J Shah, Carl van Walraven, Sun Young Jeon, John Boscardin, F D Richard Hobbs, Stuart J Connolly, Michael D Ezekowitz, Kenneth E Covinsky, Margaret C Fang, Daniel E Singer

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Circulation. Cardiovascular quality and outcomes, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
4.0field-weighted citation impact, top 6% 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

3 citing papers in PubMed, 10 citations in OpenAlex.

  1. Article
  2. Review
  3. Comparing CHAThe Lancet regional health. Europe · 2024
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 6 institutions in 3 countries.

Sachin J ShahDivision of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (S.J.S., D.E.S.).ORCID 0000-0001-8400-6888
Carl van WalravenDepartments of Medicine and Epidemiology and Community Medicine, University of Ottawa, ON, Canada (C.v.W.).ORCID 0000-0002-8390-0930
Sun Young JeonDepartments of Medicine (S.Y.J., W.J.B., K.E.C., M.C.F.), University of California San Francisco, San Francisco, CA.ORCID 0000-0002-7963-6604
John BoscardinDepartments of Medicine (S.Y.J., W.J.B., K.E.C., M.C.F.), University of California San Francisco, San Francisco, CA.ORCID 0000-0003-3121-9526
F D Richard HobbsNuffield Department of Primary Care Health Sciences, University of Oxford, UK (F.D.R.H.).ORCID 0000-0001-7976-7172
Stuart J ConnollyPopulation Health Research Institute, McMaster University, Hamilton, ON, Canada (S.C.).ORCID 0000-0002-7377-335X
Michael D EzekowitzDepartment of Medicine, Thomas Jefferson University, Philadelphia, PA (M.E.).
Kenneth E CovinskyDepartments of Medicine (S.Y.J., W.J.B., K.E.C., M.C.F.), University of California San Francisco, San Francisco, CA.
Margaret C FangDepartments of Medicine (S.Y.J., W.J.B., K.E.C., M.C.F.), University of California San Francisco, San Francisco, CA.ORCID 0000-0003-3362-1543
Daniel E SingerDivision of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA (S.J.S., D.E.S.).ORCID 0000-0001-6145-4848
University of California, San Francisco · USMassachusetts General Hospital · USNuffield Health · GBPopulation Health Research Institute · CAThomas Jefferson University · USUniversity of Ottawa · CA

Funding

VARC CoreP30AG044281 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI KENNETH E. COVINSKY · 2013 to 2026
$19.9M
Individualizing Anticoagulant use in Older Adults with Atrial FibrillationK76AG074919 · NIA · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI SHAH, SACHIN J · 2021 to 2025
$1.2M
Use and outcomes of anticoagulants for the treatment and prevention of thrombosis among hospitalized patientsK24HL141354 · NHLBI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI FANG, MARGARET C. · 2018 to 2022
$731k
NHLBI NIH HHS K24 HL141354NIA NIH HHS K76 AG074919NIA NIH HHS P30 AG044281
6 · The paper itself

Abstract

backgroundPatients with atrial fibrillation have a high mortality rate that is only partially attributable to vascular outcomes. The competing risk of death may affect the expected anticoagulant benefit. We determined if competing risks materially affect the guideline-endorsed estimate of anticoagulant benefit.

methodsWe conducted a secondary analysis of 12 randomized controlled trials that randomized patients with atrial fibrillation to vitamin K antagonists (VKAs) or either placebo or antiplatelets. For each participant, we estimated the absolute risk reduction (ARR) of VKAs to prevent stroke or systemic embolism using 2 methods-first using a guideline-endorsed model (CHA

resultsA total of 7933 participants (median age, 73 years, 36% women) had a median life expectancy of 8 years (interquartile range, 6-12), determined by comorbidity-adjusted life tables and 43% were randomized to VKAs. The CHA

conclusionsVKA anticoagulants were exceptionally effective at reducing stroke risk. However, VKA benefits were misestimated with CHA

Indexed as

Atrial FibrillationStrokeAgedAnticoagulantsFemaleFibrinolytic AgentsHumansMaleRandomized Controlled Trials as TopicRisk AssessmentRisk FactorsVitamin KAnticoagulantsFibrinolytic AgentsVitamin Kanticoagulantsatrial fibrillationclinical decision-makingrisk assessmentsurvival analysis

Identifiers

PMID38525596
PMCPMC11021147
OpenAlexW4393150355

What OpenQuestion holds

Textmetadata
LicenceTDM
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.