Therapeutics: Finding a “Cure”. Why Assess Therapy Articles?. Evidence-based medicine Starting point for treatment decisions Apply evidence to your patients Quality matters. Why Does Quality Matter…?. Relative Risk vs. Quality (Trials of TCA’s in HA prevention). 27. RR. 0. 0. 8.
Relative Risk vs. Quality
(Trials of TCA’s in HA prevention)
Courtesy of Jeff Jackson, MD MPH (unpublished data)
Guyatt, et al. User’s Guide to the Medical Literature Series, No. II: How to Use an Article About Therapy or Prevention (A. ‘Are the Results of the Study Valid’ and B. ‘What were the Results and Will They Help Me in Caring for My Patients?’) Originally published in JAMA, 1993 Vol. 270(21) and 1994 Vol. 271(1)
How might you articulate a clinical question about therapeutic options for this gentleman…?
How do you manage ACS?
In NSTEMI patients with preserved LV…?
In patients with Acute Coronary Syndrome (ACS) w/o ST elevation…
…does adding clopidogrel to ASA…
…reduce cardiovascular mortality
MeSH is your friend therapeutic options for this gentleman…?
The search for a ‘CURE’…. therapeutic options for this gentleman…?
What’s so important about randomization?….
OR therapeutic options for this gentleman…?Validity
Is it worth
Proportion control – Proportion experimental
Proportion experimental – Proportion control
11.4% - 9.3% = 2.1% (composite CV mortality)
18.8% - 16.5% = 2.3% (above or refractory ischemia)
1 / 0.021 = 48 (or 1/0.23 = 43)
3.7% - 2.7% = 1% (major bleeding)
1 / 0.01 = 100 (life-threatening bleed, CVA not significant)
Proportion experimental/Proportion control
1-RR x 100%
0.093 / 0.114 = 0.80
1 - 0.8 x 100% = 20%
Compared with Absolute Risk Reduction of 2.1%